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Lack of efficacy: case report An 18-year-old male patient exhibited lack of efficacy to cytarabine and doxorubicin during treatment of acute myeloid leukaemia. The male patient, who had fatigue and fever for 2 weeks, was hospitalised, and was suspected to have developed acute promyelocytic leukaemia (APL). Thus, he was treated with arsenic-trioxide and tretinoin [all trans-retinoic acid]. However 5 days after receiving the treatment, he still complained of headache. Due to future possibility of retinoic acid differentiation syndrome, tretinoin was stopped. A gene testing was performed at that time, which ruled out a diagnosis of typical APL, and AML was thus confirmed. Targeted next-generation sequencing of the entire coding sequences of 110 mutational gene targets (known or putative) in haematologic malignancies identified a 31.69% mutation ratio of the RUNX1: c.319C>A. Thus, arsenic-trioxide was stopped and further treatment was started with standard 3 + 7 standard chemotherapy schedule comprising doxorubicin 60 mg/m2 on days 1–3, and cytarabine 100 mg/m2 on days 1–7 continuously. Despite the treatment, fibrinolysis was noted with low serum fibrinogen level and the bone marrow morphology showed abnormal promyelocytes. The male’s chemotherapy was therefore switched to HAA regimen containing omacetaxine-mepesuccinate [homoharringtonine], cytarabine and aclarubicin. A subsequent improvement was observed with this treatment. Following another cycle of consolidation therapy with HAA, he remained in complete remission. Due to personal problems, he refused further treatment. After 3 months, his disease relapsed with same morphologic, immunophenotypic and molecular features. Later, he developed coagulopathy, anal abscess and died of a severe infection [aetiologies not stated]. Wei W, et al. Alkaloid-based regimen is beneficial for acute myeloid leukemia resembling acute promyelocytic leukemia with NUP98/RARG fusion and RUNX1 mutation: A 803515638 case report. Medicine 99: No. 40, 2 Oct 2020. Available from: URL: http://doi.org/10.1097/MD.0000000000022488

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Reactions 21 Nov 2020 No. 1831