Objective: Recent advances in disease-free survival rate following organ transplantation have led to an increased incidence of malignancies after transplantation. The most common malignancies after transplantation are solid tumors, including posttransplantation lymphoproliferative diseases, sarcomas and skin carcinomas. Acute leukemias are very rare after transplantation and the incidence of acute leukemia among solid organ recipients is 0.12–2.5%. Herein, we describe a case of AML-M7 after liver transplantation.
Case report: A 10 years-old girl was admitted to our hospital because of abdominal pain and abdominal mass. An abdominal ultrasound examination showed the solid mass lesion in right adrenal region and liver. With the pathology report, the patient was diagnosed with hepatocellular carcinoma. Chemotherapy was started and surgical mass excision was made. After recurrence, liver transplantation was performed from the father. Tacrolimus was started prophylactically. Approximately 5 years after liver transplantation, the patient was referred to hematology with fatigue and leg pain. Family history revealed that mother had breast cancer and her brother died at the age of 2.5 due to hepatoblastoma. She was pancytopenic and bone marrow aspiration and biopsy revealed acute myeloid leukemia with flow cytometry AML FAB M7 was diagnosed. AML BFM 2019 protocol was initiated. Cytogenetic and molecular work-up from bone marrow samples revealed only monosomy 7. Familial cancer susceptibility genes revealed p53 gene mutation and BRCA2 gene mutations. Hematopoietic stem cell transplantation was planned.
Results: Immunosuppressive treatments used after liver transplantation may have impact on secondary cancer development, additionally genetic familial risks in our patient may also have contributed to subsequent leukemia development.
Conclusion: The development of AML after liver transplantation is a relatively rare complication and several such cases of AML have been reported, previously. Immunosuppressive treatments used after liver transplantation may have impact on secondary cancer development, additionally genetic familial risks in our patient may also have contributed to subsequent leukemia development.
