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Case Reports
. 2024 Sep 16;16(9):e69548.
doi: 10.7759/cureus.69548. eCollection 2024 Sep.

Acute Lymphoblastic Leukemia in a Patient With Advanced Breast Cancer Treated With Cyclin-Dependent Kinase 4/6 Inhibitors and Endocrine Therapy

Ryan E Bailey  1 , Marcela Mazo Canola  2
Affiliations
Case Reports

Acute Lymphoblastic Leukemia in a Patient With Advanced Breast Cancer Treated With Cyclin-Dependent Kinase 4/6 Inhibitors and Endocrine Therapy

Ryan E Bailey et al. Cureus. .

Abstract

This case shares the case of a post-menopausal woman who develops Philadelphia chromosome-positive B cell acute lymphoblastic leukemia (B-ALL) while receiving treatment for invasive ductal carcinoma (IDC) of the breast. The patient received a cyclin-dependent kinase (CDK) 4/6 inhibitor + aromatase inhibitor (AI) for the IDC; hyperfractionate cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride (Adriamycin), methotrexate, and cytarabine (hyperCVAD), and the steroid hormone dexamethasone were added to treat the B-ALL. HyperCVAD combined with CDK 4/6 inhibitor + AI was very well tolerated. The CDK 4/6 inhibitor and AI were only held once in the treatment course due to adverse effect (AE) intolerance. The patient remains on a CDK 4/6 inhibitor and ponatinib with only low-grade fatigue as an AE. This case underscores the importance of a concurrent approach to managing hematologic and breast malignancies. The combined treatment regimens were effective and well-tolerated. Vigilant follow-up is essential for patients in remission from both malignancies, ensuring effective disease surveillance and treatment management. Integrated care remains pivotal for optimal outcomes.

Keywords: acute lymphoblastic leukemia; aromatase inhibitor therapy; b-cell acute lymphoblastic leukemia; breast cancer management; cdk 4/6 inhibitors.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. UT Health San Antonio IRB issued approval STUDY00000714. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Arches of neoplastic cells in a cribriform pattern accompanied by desmoplastic stroma (hematoxylin and eosin, 40x magnification)
Black boxes outline areas of cribriform architecture.
Figure 2
Figure 2. Neoplastic cells display nuclei with vesicular chromatin and mild pleomorphism (hematoxylin and eosin, 400x magnification)
Arrows denote cells with vesicular chromatin.
Figure 3
Figure 3. Immunohistochemical staining of breast biopsy
(A) >95% ER positivity with strong intensity, 10x magnification; (B) >95% ER positivity with strong intensity, 40x magnification; (C) >95% PR positivity with strong intensity, 10x magnification; (D) >95% PR positivity with strong intensity, 40x magnification. Regions of enhanced signal intensity have been demarcated by black outlines. ER: Estrogen receptor; PR: Progesterone receptor
Figure 4
Figure 4. Low power peripheral blood smear showing blasts
Black arrows indicate blasts.
Figure 5
Figure 5. Blasts in the bone marrow touch preparation
Arrows indicate some of the blasts in the figure.
Figure 6
Figure 6. Bone marrow core biopsy, high power
Arrows indicate blasts in the bone marrow.
See this image and copyright information in PMC

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