Azathioprine-associated acute myeloid leukemia in a patient with Crohn's disease and thiopurine S-methyltransferase deficiency

Paul R Yenson, Donna Forrest, Kjell Schmiegelow, Bakul I Dalal

Abstract

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.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Hematology
Vol/bind83
Udgave nummer1
Sider (fra-til)80-3
Antal sider4
ISSN0361-8609
DOI
StatusUdgivet - jan. 2008

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