• PDF / 170,544 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 91 Downloads / 146 Views

DOWNLOAD

REPORT

---

1 S

Acute myeloid leukaemia: case report A 68-year-old man developed acute myeloid leukaemia (AML) during treatment with melphalan and lenalidomide for multiple myeloma (MM) [routes and durations of treatment to reactions onset not stated]. The man, who was diagnosed with stage I IgG κ MM in April 2014 at the age of 66 years, started receiving bortezomib, cyclophosphamide, and dexamethasone. He achieved partial response after the induction therapy. Following the stem cell mobilisation, conditioning regimen including melphalan 140 mg/m2 on day 2 and busulfan was administered prior to the reinfusion of autologous stem cells. In April 2015, a complete response was noted. On day 100 post autologous stem cell transplantation (ASCT), lenalidomide maintenance therapy was initiated at a dose of 10mg daily. In May 2016 at the age of 68 years, severe neutropenia and thrombocytopenia were noted on routine follow-up. Bone marrow aspiration revealed 35% blasts immunophenotypically positive for CD34, CD33, CD13 and CD117 suggestive of AML. Metaphase analysis showed no karyotypic abnormalities and Sanger sequencing showed two CEBPA mutations. The man’s lenalidomide was discontinued. Afterwards, a gradual improvement in peripheral blood counts was noted and no further therapy was required. Bone marrow examination at six weeks following the discontinuation of lenalidomide showed remission with less than 5% blasts. CEBPA mutational analysis by quantitative digital droplet polymerase chain reaction (ddPCR) of the marrow sample also confirmed a molecular remission. Twelve months following the discontinuation, sustained response of the myeloma and normalisation of the peripheral blood counts was noted. In late April 2017, bone marrow examination on follow-up revealed AML relapse 12 months after the initial presentation with progressive cytopenias with the same two CEBPA mutations suggestive of clonal evolution. Karyotypic analysis showed monosomy 7 confirmed by whole-genome sequencing. He received treatment with cytarabine and idarubicin followed by allogeneic transplantation. He remained in remission from both his MM and AML. He died 461 days from allogeneic transplantation due to pneumonia. Waller DD, et al. Spontaneous remission and clonal evolution in lenalidomide associated secondary AML. Leukemia and Lymphoma 61: 1724-1727, No. 7, 2020. Available 803499746 from: URL: http://doi.org/10.1080/10428194.2020.1725504

0114-9954/20/1820-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 5 Sep 2020 No. 1820