PDF(Pubmed)
Abstract：
BACKGROUND: Because there are few evidence-based guidelines and an extremely low incidence rate, managing and treating patients who have transitioned from acute promyelocytic leukemia (APL), which was diagnosed during pregnancy, to acute myeloid leukemia (AML), can be difficult.
METHODS: In this case, a 34-year-old pregnant patient was diagnosed with APL in medium-risk group in June 2017. After the all-trans retinoic acid and arsenic trioxide-based full-course treatment, the patients achieved complete remission (CR) and were well-tolerated. After 5 years, the patient complained of fatigue for 3 months.
METHODS: Bone marrow examination revealed hypercellularity with approximately 50% immunophenotypic abnormal myeloblasts with MLL-AF9 fusion gene. Based on the AML diagnosis criteria of the World Health Organization, the patient was eventually diagnosed with a rare transformation from APL to AML.
METHODS: The patient was treated with two cycles of induction chemotherapy and an allogeneic hematopoietic stem cell transplantation (allo-HSCT).
RESULTS: Until now, the patient is in continuous remission with no signs of APL and AML.
CONCLUSIONS: Despite the rarity of APL to AML transformation, it is crucial to track the disease\'s progress and administer treatment on time. It remains uncertain whether the risk stratification and clinical outcomes of secondary AML with MLL-AF9 are equivalent to those of de novo AML with MLL-AF9. The management and treatment of these patients should be personalized and require further observation.
METHODS: In this case, a 34-year-old pregnant patient was diagnosed with APL in medium-risk group in June 2017. After the all-trans retinoic acid and arsenic trioxide-based full-course treatment, the patients achieved complete remission (CR) and were well-tolerated. After 5 years, the patient complained of fatigue for 3 months.
METHODS: Bone marrow examination revealed hypercellularity with approximately 50% immunophenotypic abnormal myeloblasts with MLL-AF9 fusion gene. Based on the AML diagnosis criteria of the World Health Organization, the patient was eventually diagnosed with a rare transformation from APL to AML.
METHODS: The patient was treated with two cycles of induction chemotherapy and an allogeneic hematopoietic stem cell transplantation (allo-HSCT).
RESULTS: Until now, the patient is in continuous remission with no signs of APL and AML.
CONCLUSIONS: Despite the rarity of APL to AML transformation, it is crucial to track the disease\'s progress and administer treatment on time. It remains uncertain whether the risk stratification and clinical outcomes of secondary AML with MLL-AF9 are equivalent to those of de novo AML with MLL-AF9. The management and treatment of these patients should be personalized and require further observation.
摘要：
背景：因为基于证据的指南很少，发生率极低，管理和治疗从急性早幼粒细胞白血病（APL）过渡的患者，在怀孕期间被诊断出来，急性髓系白血病（AML），可能很难。
方法：在这种情况下，1例34岁的孕妇于2017年6月被诊断为中风险组的APL.经过全反式维甲酸和三氧化二砷的全程治疗，患者达到完全缓解(CR),且耐受性良好.五年后,患者主诉疲劳3个月。
方法：骨髓检查显示细胞增多，约有50％的免疫表型异常成髓细胞带有MLL-AF9融合基因。根据世界卫生组织的AML诊断标准，患者最终被诊断为罕见的APL转化为AML.
方法：患者接受两个周期的诱导化疗和异基因造血干细胞移植（allo-HSCT）治疗。
结果：直到现在，患者持续缓解,无APL和AML征象.
结论：尽管APL很少转化为AML，跟踪疾病的进展并按时进行治疗是至关重要的。目前尚不确定MLL-AF9继发性AML的风险分层和临床结果是否等同于MLL-AF9新生AML的风险分层和临床结果。这些患者的管理和治疗应个性化，需要进一步观察。
方法：在这种情况下，1例34岁的孕妇于2017年6月被诊断为中风险组的APL.经过全反式维甲酸和三氧化二砷的全程治疗，患者达到完全缓解(CR),且耐受性良好.五年后,患者主诉疲劳3个月。
方法：骨髓检查显示细胞增多，约有50％的免疫表型异常成髓细胞带有MLL-AF9融合基因。根据世界卫生组织的AML诊断标准，患者最终被诊断为罕见的APL转化为AML.
方法：患者接受两个周期的诱导化疗和异基因造血干细胞移植（allo-HSCT）治疗。
结果：直到现在，患者持续缓解,无APL和AML征象.
结论：尽管APL很少转化为AML，跟踪疾病的进展并按时进行治疗是至关重要的。目前尚不确定MLL-AF9继发性AML的风险分层和临床结果是否等同于MLL-AF9新生AML的风险分层和临床结果。这些患者的管理和治疗应个性化，需要进一步观察。
