Clinical Pearls in Blood Diseases
Azathioprine-associated acute myeloid leukemia in a patient with Crohn's disease and thiopurine S-methyltransferase deficiency
Article first published online: 15 AUG 2007
Copyright © 2007 Wiley-Liss, Inc.
American Journal of Hematology
Volume 83, Issue 1, pages 80–83, January 2008
How to Cite
Yenson, P. R., Forrest, D., Schmiegelow, K. and Dalal, B. I. (2008), Azathioprine-associated acute myeloid leukemia in a patient with Crohn's disease and thiopurine S-methyltransferase deficiency. Am. J. Hematol., 83: 80–83. doi: 10.1002/ajh.21014
- Issue published online: 10 DEC 2007
- Article first published online: 15 AUG 2007
- Manuscript Accepted: 22 MAY 2007
- Manuscript Received: 17 MAY 2007
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.