Disease-Specific Hashtags for Online Communication About Cancer Care

Abstract

Case 3. In 2012, a young adult man with history of Klinefelter syndrome presented with intermittent chest pain and was found to have a 15-cm primary mediastinal NSGCT.He was treated with 4 cycles of VIP followed by resection of residual mediastinal mass, which revealed teratoma.In 2014, he was found to have leukocytosis (WBC, 44 000/μL [44.0 × 10 9 / L]).Bone marrow examination confirmed chronic-phase CML by morphologic characteristics, and a t(9;22)(q34;q11) was identified by chromosome analysis.The patient started treatment with dasatinib and achieved a hematologic response.To date, his BCR/ABL transcript declined appropriately from 55% to 9%.He continues to be in remission for his GCT.Discussion | There have been reports of chemotherapy-related Philadelphia-chromosome leukemias in patients with antecedent malignant neoplasms.3 Past treatments for GCT with cisplatin-etoposide-containing regimens or HDCT with carboplatin-etoposide have been linked to an increased risk of secondary acute leukemia 1,4 and solid tumors.5 A review of the literature reveals 7 cases of GCT with subsequent development of CML.1,3,6 In this series, we present 3 cases of patients with GCT who achieved remission with chemotherapy and later developed BCR/ABL-positive CML.These findings raise the question of a causal relationship between etoposide and/or platinum-containing chemotherapy and the development of CML with t(9;22)(q34;q11).Etoposide-based chemotherapy in patients with GCT is leukemogenic.It is not clear whether combination chemotherapy with cisplatin and bleomycin contribute to this result.While its association with AML is well established, questions regarding the connection of etoposide and cisplatincontaining combination chemotherapy and secondary CML are posed herein.The relatively low risk of secondary leukemia in patients treated with potentially curative combination chemotherapy for GCT continues to be reassuring. 1 However, physicians should be aware of possible late toxic effects of these treatment regimens and the need for diligent follow-up in these patients.

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