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Azathioprine‐associated acute myeloid leukemia in a patient with Crohn's disease and thiopurine S ‐methyltransferase deficiency
Author(s) -
Yenson Paul R.,
Forrest Donna,
Schmiegelow Kjell,
Dalal Bakul I.
Publication year - 2008
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.21014
Subject(s) - thiopurine methyltransferase , mercaptopurine , azathioprine , medicine , myeloid leukemia , leukemia , immunology , disease , gastroenterology , cancer research
Immunosuppressive thiopurines like azathioprine, 6‐mercaptopurine, and thioguanine are commonly used in inflammatory and neoplastic disorders. A subset of these patients are genetically slow metabolizers due to point‐mutations in enzyme thiopurine S ‐methyltransferase (TPMT), and are at a higher risk of hematologic toxicity and leukemogenesis. We present such a patient who was a slow metabolizer for azathioprine, and developed a rapidly lethal form acute myeloid leukemia after relatively low dose exposure to the drug. There was prominent hemophagocytic activity in the bone marrow, and cytogenetic analysis showed a complex karyotype with monosomy 7, but no involvement of chromosome 8. Am. J. Hematol., 2008. © 2007 Wiley‐Liss, Inc.