ABSTRACT
This study aimed to delineate the possible impact of COVID-19 on acute myeloid leukemia (AML) patients in terms of diagnosis, chemotherapy, bone marrow transplant, and vaccination response. Allogeneic stem cell transplantation is markedly affected by the COVID-19 pandemic, as both donors and recipients must be healthy for transplantation to be feasible and successful. Delays in the identification of well-matched donors have been predicted, and represent a special challenge. Therefore, future donors should be tested for COVID-19. The outcome of delayed transplantation is vague and masked by variations in stem cell source along with disease subtype. However, if transplant delay results in recurrence of minimal residual disease, a negative impact on survival is anticipated.
ABSTRACT
Context: Acute myeloid leukemia (AML) is rarely presented with thrombocytosis and marked thrombocytosis with a platelet count over 1.0×1012/L is an extremely rare phenomenon. Objective: A case of de novo AML with unusual presentation by extreme thrombocytosis. Design: A case report. Setting: Hematology Unit at the Oncology Center Mansoura University, Egypt. Patient: A 37-year-old male patient with a history of sleeve gastrectomy in 2020, presented with oral mucositis, recurrent abscess, fever, and bilateral axillary lymphadenopathy. Initial complete blood count (CBC) showed a Hb level of 6 g/dL, a platelet count of 1.685×109/L, and a white blood cell (WBC) count of 19×109/L. Diagnosis of de novo AML (FAB-M2 AML) was confirmed by bone marrow aspiration, biopsy, and immunophenotyping. Cytogenetic study showed negative t(8;21)/inv 16/ t(9;22). A molecular study showed positive FLT-3 mutation and negative BCP/ABL1, JAK2, V617F, and CALR exon 9 mutations excluding blast transformation on top of myeloproliferative neoplasm (MPN) and myelodysplastic syndrome (MDS). Interventions: The patient received induction chemotherapy including a course of 7-day-cytarabine along with 3-day-anthracycline on September 20th, 2021 but the patient was refractory as BMA showed blast cells 75%. The patient started salvage HAM (high-dose cytosine arabinoside and mitoxantrone) + Sorafenib on November 6th, 2021. Again, he could not achieve a response and received FLAG (high-dose cytosine arabinoside, fludarabine, and granulocyte colony-stimulating factors) + Sorafenib on December 18th, 2021, after recovery from COVID-19 infection. Main Outcome Measures: To shed light on fact that myeloid neoplasms as MPN, MDS, and de novo AML can share overlapping features. Results: On January 25th, 2022, the last CBC showed a Hb level of 8.4 g/dL, a platelet Count of 395×109/L, and a WBC Count of 2.41×109/L with a differential Neutrophil count of 0.24×109/L. The patient lost follow-up since then. Conclusions: Only a few AML cases have been reported with thrombocytosis. Detailed molecular studies are mandatory to confirm the diagnosis of de novo AML patients with unusual presentation. Careful follow-up of those cases could help in establishing management guidelines for better outcomes as those patients usually have a poor prognosis.
ABSTRACT
Context: The incidence of malignancy increases after solid organ transplantation, which might be related to recipients' age and immunosuppressive drugs;this is accounted as the 3rd leading cause of death. Therefore, understanding cancer facts after transplantation is mandatory for transplant recipients' long-term care. Objective: A case study of a secondary acute myeloid leukemia (AML) patient after renal transplant complicated by COVID-19 infection. Design: A case report. Setting: Hematology Unit/Oncology Center, Mansoura University, Egypt. Patient: A 53-year-old male patient with a history of renal transplant due to end-stage renal failure since 2001. He was on steroids, cyclosporine (CSA), and mycophenolate mofetil since then. On December 31st, 2019, AML diagnosis (FAB-M4 AML) was confirmed by bone marrow aspiration (BMA), biopsy, and immunophenotyping (IPT). Cytogenetic and molecular analyses were negative for t(8;21), t(15;17), t(16;16), and FLT3 mutation. Interventions: He received induction chemotherapy with dose-adjusted 7+3, and immunosuppressant doses were reduced to steroids 10 mg and CSA 75 mg. BMA at D+28 showed complete remission (CR). The response was consolidated by 2 cycles of 5+2. On May 4th, 2020, CBC showed leukocytosis and anemia;BMA showed normocellular marrow with 5% blasts. Thus, he received 5 days of mitoxantrone with etoposide, and BMA reassessment was in CR. The patient's performance (PS) worsens after chemotherapy, so he continued subcutaneous cytarabine. On June 30th, 2020, the patient presented with fever and dyspnea. Relapse was confirmed by IPT and FLT-3 positivity. Chest high-resolution computed tomography (HRCT) showed bilateral mild pleural effusion and cardiomegaly. COVID-19 PCR was positive. Main Outcome Measures: The challenge was how to deal with relapse, COVID-19, and poor PS and kidney condition. He received dose-adjusted hydroxyurea with supportive measures, anticoagulant, and continued steroids. Results: Unfortunately, on August 4th, 2020, the patient was admitted to the ICU with disturbed consciousness and hyperleukocytosis with progression of HRCT and died. Conclusions: Our case had a unique presentation as the diagnosis of AML was very late after renal transplant. Managing the case was challenging as there is no consensus for this category of patients with the dilemma associated with their disease and the additional COVID-19 burden. Further studies are needed to validate a chemotherapy protocol for these patients.