Acute Promyelocytic Leukemia with double minute chromosomes: a rare case with high relapse risk

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML); it has a high response rate and long-term survival with differentiation therapy and chemotherapy. However, only one previous case of APL with double minute chromosomes (DMs, a poor prognostic factor for AML) has been reported. We report the case of a patient with APL and DMs. A 44-year-old woman was treated with all-trans retinoic acid (ATRA) and chemotherapy and achieved molecular complete remission (mCR). However, the condition relapsed after 15 months. She was treated with arsenic trioxide and autologous transplantation and experienced mCR. Her peripheral blood was positive for minimal residual disease (MRD) 2 months after autologous transplantation. She became MRD-negative with ATRA and has maintained the negative status for 15 months. This is the first report to suggest that patients with APL and DMs may be a high-risk group for relapse and benefit from maintaining with ATRA.