Acute Myeloid Leukemia After Radium-223 Therapy: Case Report

Radium-223 (Ra-223) is the first radiopharmaceutical with disease modifying properties in metastatic castration-resistant prostate cancer (mCRPC). A recent long-term follow-up of hematologic toxicities reported no cases of primary or secondary hematologic malignancies. We describe what is to our knowledge the first case of acute myelogenous leukemia (AML) after therapy with Ra-223. The patient was a 69-year-old man with a medical history of mCRPC and coronary artery disease who was transferred to our hospital after a 3-day history of abdominal pain and diarrhea. He became febrile and neutropenic during admission. Analysis of the peripheral smear by 2 independent pathologists and a hematologist demonstrated approximately 40% to 50% blasts, supporting the diagnosis of AML. Further analysis of medical records demonstrated that the patient received numerous therapies over time, including radiotherapy and Ra-223, which could potentially have resulted in accumulated bone marrow insult. Although we cannot definitively establish the etiologic role of Ra-223 in the development of AML on this case, our findings should help increase awareness among clinicians that the cumulative effects of bone-targeting radiopharmaceuticals combined with radiotherapy carry risks. (C) 2016 Elsevier Inc. All rights reserved.