Department of Internal Medicine, Rochester General Hospital, Rochester, NY
14621.
Mitoxantrone is a DNA-topoisomerase 2 inhibitor used as a single
agent for treatment of relapsing-remitting or progressive multiple sclerosis
(MS). We present here two patients treated with mitoxantrone for MS who
subsequently developed acute promyelocytic leukemia (APL). These constitute, to
our knowledge, the eighth and ninth reports of APL in patients treated with
mitoxantrone for MS. Topoisomerase 2 inhibitors are associated with
therapy-related acute myeloid leukemia (t-AML) with 11q23 abnormalities, but
therapy-related APL (t-APL) is less common, and documentation of nine cases of
t-APL after mitoxantrone therapy for MS suggests a specific association.
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