TP53-mutated Therapy-related Leukemia with the Der(5;17)(p10;q10) Chromosomal Abnormality Following Chemotherapy for Acute Promyelocytic Leukemia Bridged to Allogeneic Hematopoietic Stem Cell Transplantation Using CPX-351.

A 49-year-old man developed therapy-related acute myeloid leukemia (t-AML) nine years after undergoing treatment for acute promyelocytic leukemia. A genetic analysis revealed a TP53 mutation and a complex karyotype featuring der(5;17)(p10;q10) translocation. This combination is associated with an extremely poor prognosis and chemoresistance. However, the patient achieved complete remission with CPX-351 (liposomal daunorubicin/cytarabine) and subsequently underwent allogeneic hematopoietic stem cell transplantation. He has remained in remission for over five months after the transplant. CPX-351 followed by early transplantation may be an important therapeutic option for selected high-risk patients, such as those with TP53-mutatied t-AML.