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Cytarabine/daunorubicin Lineage switch of acute myeloid leukaemia to acute megakaryoblastic leukaemia: case report

A 62-year-old man exhibited a lineage switch of acute myeloid leukaemia to acute megakaryoblastic leukaemia following cytarabine and daunorubicin chemotherapy. The man presented with anaemia, thrombocytopenia and marked leucocytosis with markedly increased circulating blasts. Based on relevant investigations, he was diagnosed with acute myeloid leukaemia with maturation (AML-M2). He received standard induction chemotherapy with cytarabine plus daunorubicin, 7 + 3 regimen [routes and dosage not stated]. Sixteen days after the induction, a bone marrow biopsy showed 35% blasts and a profound proliferation of dysplastic megakaryocytes, mostly small hypolobate forms. The blasts were positive for factor 8-related antigen and CD31. Flow cytometry showed 24% blasts that were positive for bright CD41 and moderate CD61. The lineage of the leukaemia cells was apparently converted to megakaryoblastic lineage (AML-M7). Conventional cytogenetics revealed a tetraploid clone in four metaphase cells: 92,XXYY[4]/46,XY[14]. NGS analysis demonstrated the same mutation profile as the previous analysis with a similar variant allele frequency (VAF) in each mutation. Due to the lineage switch i.e. transformation, the man’s chemotherapy was changed to high-dose daunorubicin plus mitoxantrone (7 + 3 regimen). Despite aggressive measures, 30 days after the induction, he died due to severe pancytopenia, a manifestation of acute megakaryoblastic leukaemia, and a sudden intracranial haemorrhage. Zhao Y, et al. Acute myeloid leukaemia with maturation demonstrates persistent disease with prominent megakaryoblastic differentiation 16 days following induction chemotherapy: an intra-myeloid lineage switch mediated by chemotherapy-induced clonal selection. British Journal of Haematology 189: e64-e67, No. 3, May 2020. Available 803508275 from: URL: http://doi.org/10.1111/bjh.16476

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Reactions 17 Oct 2020 No. 1826