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Clinical and Pathologic Features of Secondary Acute Promyelocytic Leukemia

Amy S. Duffield MD, PhD, Joseph Aoki MD, Mark Levis MD, PhD, Kathleen Cowan MT(ASCP), Christopher D. Gocke MD, Kathleen H. Burns MD, PhD, Michael J. Borowitz MD, PhD, Milena Vuica-Ross MD, PhD
DOI: http://dx.doi.org/10.1309/AJCPE0MV0YTWLUUE 395-402 First published online: 1 March 2012


Acute promyelocytic leukemia (APL) is a relatively common form of acute myeloid leukemia (AML) that has an excellent prognosis. In contrast, secondary acute myeloid leukemias, including therapy-related AML and AML with myelodysplasia-related changes, have a relatively poor prognosis. We identified 9 cases of APL at our institution in which there was a history of chemotherapy, radiotherapy, chronic immunosuppression, or antecedent myelodysplastic syndrome. The clinical and pathologic findings in these cases of secondary APL were compared with the clinical and pathologic findings in cases of de novo APL. We found that secondary and de novo APL had abnormal promyelocytes with similar morphologic and immunophenotypic features, comparable cytogenetic findings, comparable rates of FMS-like tyrosine kinase mutations, and similar rates of recurrent disease and death. These data suggest that secondary APL is similar to de novo APL and, thus, should be considered distinct from other secondary acute myeloid neoplasms.

Key Words:
  • Acute promyelocytic leukemia
  • APL
  • Therapy-related acute myeloid leukemia
  • Therapy-related myeloid neoplasm
  • Acute myeloid leukemia with myelodysplasia-related changes
  • Flow cytometry
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