Acute Lymphoblastic Leukemia Following Nasopharyngeal Carcinoma: Report of an Unusual Case

Document Type: Case Report


1 Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Radiotherapy and Oncology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.


Nasopharyngeal carcinoma (NPC) is a rare malignancy in children. Nasal obstruction, otitis media with effusion, pain in the ear, hearing problems, and unusual neck mass are among the signs and symptoms of this malignancy.
Case Report:
We report the case of a 13-year-old girl with NPC who later developed acute lymphoblastic leukemia (ALL) through the course of her disease. To our knowledge, this is the first report of ALL following childhood nasopharyngeal carcinoma in the English-language literature.
Reports of secondary malignancies at the site of radiotherapy for NPC exist, but this is the first report of ALL following NPC.


Main Subjects



1. Mertens R, Granzen B, Lassay L, Gademann G, Hess CF, Heimann G.Nasopharyngeal carcinoma in childhood and adolescence . Cancer 1997; 80: 951–9.

2. Ingersol L, Woo SY, Donaldson S, Geisler J, Maor MH, Goffinet D, et al. Nasopharyngeal carcinoma in the young: a combined M.D. Anderson and Stanford experience. Int J Radiat Oncol Biol Phys 1990; 19: 881–7.

3. Liebowitz D. Nasopharyngeal carcinoma: the Epstein-Barr virus association. Semin Oncol 1994; 21: 376–81.

4. Yu MC, Yuan JM. Epidemiology of nasopharyngeal carcinoma. Seminars in Cancer Biology 2002; 12: 421–9.

5. Cheuk DK, Billups CA, Martin MG, Ronald C,  Riberio R, Krasin M, et al.  Prognostic factors and long-term outcomes of childhood nasopharyngeal carcinoma. Cancer 2011; 117(1): 197–206.

6. Wolden SL, Steinherz PG, Kraus DH, Zelefsky MJ, Pfister DG, Wollner N. Improved long-term survival with combined modality therapy for pediatric nasopharynx cancer. Int J Radiat Oncol Biol Phys 2000; 46(4): 859–64.

7. Casanova M, Bisogno G, Gandola L, Cecchetto G, Di Cataldo A, Basso E, et al. A prospective protocol for nasopharyngeal carcinoma in children and adolescents: the Italian Rare Tumors in
 Pediatric Age (TREP) project. Cancer 2012; 118(10): 2718–25.

8. Ayan I, Kaytan E, Ayan N. Childhood nasopharyngeal carcinoma: from biology to treatment. Lancet Oncology 2003; 4(1): 13–21.

9. Liu W, Tang Y, Gao L, Huang X, Luo J, Zhang SH, Wang K, et al. Nasopharyngeal carcinoma in children and adolescents ­– a single institution experience of 158 patients. Radiation Oncology 2014; 9: 274.

10. Downing NL, Wolden S, Wong P, Petrik DW, Hara W, Le QT. Comparison of treatment results between adult and juvenile nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2009, 75:1064–70.

11. Ozyar E, Selek U, Laskar S, Uzel O, Anacak Y, Ben-Arush M, et al. Treatment results of 165 pediatric patients with non-metastatic nasopharyngeal carcinoma: a Rare Cancer Network study. Radiother Oncol 2006, 81:39–46. 

12. Kupeli S, Varan A, Ozyar E, Atahan IL, Yalcin B, Kutluk T, et al. Treatment results of 84 patients with nasopharyngeal carcinoma in childhood. Pediatr Blood Cancer 2006, 46:454–8. 

13. Wei WI, Sham JS. Nasopharyngeal carcinoma. Lancet 2005; 365:2041–45.

14. Laskar S, Sanghavi V, Muckaden MA, Ghosh S, et al. Nasopharyngeal carcinoma in children: ten years experience at the Tata Memorial Hospital, Mubai. Int J Radiat Oncol Biol Phys 2004; 58: 189–95.

15. Hu S, Xu X, Xu J, Xu Q, Liu S. Prognostic factors and long-term outcomes of nasopharyngeal carcinoma in children and adolescents. Pediatr Blood Cancer 2013; 60: 1122–7.

16. Jenkin RD, Anderson JR, Jereb B, Thompson JC, Pyesmany A, Wara W, et al. Nasopharyngeal carcinoma- A retrospective review of patients less than thirty years of age. A report of children’s cancer study group. Cancer 1981; 47: 360–6.

17. Sahraoui S, Acharki A, Benider A, Bouras N, Kahlain A. nasopharyngeal carcinoma in children under 15 years of age: A retrospective review of 65 patients. Ann Oncol 1999; 10: 1499–502.

18. Cvitkovic E, Bauchouchi M, Boussen H, Busson P, Rousselet G, Mahjoubi R, et al. Leukemoid reaction, bone marrow invasion, fever of unknown origin and metastatic pattern in the natural history of advanced undifferentiated carcinoma of nasopharyngeal type a review of 255 consecutive cases. J Clin Oncol 1993; 11: 2434–42.

19. Saussez S, Heimann P, Vandevalde L, Bisschop P, Jortay A, Schanden L, et al. Undifferentiated carcinoma of the nasopharynx and leukemoid reaction: report of case with literature review. J Laryngol Otol 1997; 111: 66–9.

20. Liaw CC, Chen JS, Wang CH, Chang HK, Huang JS. Tumor fever in patients with nasopharyngeal carcinoma : clinical experience of 67 patients. Am J lin Oncol 1998; 21: 422–5.