Cargando…

A case report of complete remission of acute myeloid leukemia combined with DNMT3A, FLT3-TKD, and IDH2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine

In March 2022, a 58-year-old man was admitted to the local hospital for nausea and vomiting. His blood routine indicated that he had leukocytosis and anemia. The patient was diagnosed with acute myeloid leukemia (AML)-M5b accompanied by DNMT3A, FLT3-TKD, and IDH2 mutations, chest CT revealed pulmona...

Descripción completa

Detalles Bibliográficos
Autores principales: Ji, Lin, Yang, Wei, Xu, Xiao-feng, Xu, Ya-qing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10294669/
https://www.ncbi.nlm.nih.gov/pubmed/37384044
http://dx.doi.org/10.3389/fmed.2023.1180757
_version_ 1785063240013709312
author Ji, Lin
Yang, Wei
Xu, Xiao-feng
Xu, Ya-qing
author_facet Ji, Lin
Yang, Wei
Xu, Xiao-feng
Xu, Ya-qing
author_sort Ji, Lin
collection PubMed
description In March 2022, a 58-year-old man was admitted to the local hospital for nausea and vomiting. His blood routine indicated that he had leukocytosis and anemia. The patient was diagnosed with acute myeloid leukemia (AML)-M5b accompanied by DNMT3A, FLT3-TKD, and IDH2 mutations, chest CT revealed pulmonary tuberculosis (TB). Acid-fast bacillus (AFB) was detected in sputum. The patient then received anti-TB treatment with isoniazid + rifampicin + pyrazinamide + ethambutol. On April 8, he was transferred to our hospital's Hematology Department after three consecutive negative sputum smears. He was administered the VA (Venetoclax + Azacytidine) regimen of anti-leukemia treatment and also received levofloxacin + isohydrazide + pyrazinamide + ethambutol anti-TB treatment. After one course of VA therapy, there was no remission in the bone marrow. Therefore, the patient received the HVA (Homeharringtonine + Venetoclax + Azacytidine) regimen of anti-leukemia treatment. On May 25, the bone marrow smear revealed that the original mononuclear cells were 1%. Moreover, bone marrow flow cytometry revealed the absence of any abnormal cells. mNGS showed DNMT3A (mutation rate 44.7%), but no mutations were detected in FLT3-TKD and IDH2. The patient then received the HVA regimen three consecutive times, resulting in complete remission. Repeated chest CT examinations revealed progressive regression of pulmonary TB foci, no AFB was detected in the sputum. This AML patient with DNMT3A, FLT3-TKD, and IDH2 mutations and active TB is difficult to treat. It is very necessary for him to administer prompt anti-leukemia treatment under the premise of active anti-TB treatment. The HVA regimen is effective for this patient.
format Online
Article
Text
id pubmed-10294669
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-102946692023-06-28 A case report of complete remission of acute myeloid leukemia combined with DNMT3A, FLT3-TKD, and IDH2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine Ji, Lin Yang, Wei Xu, Xiao-feng Xu, Ya-qing Front Med (Lausanne) Medicine In March 2022, a 58-year-old man was admitted to the local hospital for nausea and vomiting. His blood routine indicated that he had leukocytosis and anemia. The patient was diagnosed with acute myeloid leukemia (AML)-M5b accompanied by DNMT3A, FLT3-TKD, and IDH2 mutations, chest CT revealed pulmonary tuberculosis (TB). Acid-fast bacillus (AFB) was detected in sputum. The patient then received anti-TB treatment with isoniazid + rifampicin + pyrazinamide + ethambutol. On April 8, he was transferred to our hospital's Hematology Department after three consecutive negative sputum smears. He was administered the VA (Venetoclax + Azacytidine) regimen of anti-leukemia treatment and also received levofloxacin + isohydrazide + pyrazinamide + ethambutol anti-TB treatment. After one course of VA therapy, there was no remission in the bone marrow. Therefore, the patient received the HVA (Homeharringtonine + Venetoclax + Azacytidine) regimen of anti-leukemia treatment. On May 25, the bone marrow smear revealed that the original mononuclear cells were 1%. Moreover, bone marrow flow cytometry revealed the absence of any abnormal cells. mNGS showed DNMT3A (mutation rate 44.7%), but no mutations were detected in FLT3-TKD and IDH2. The patient then received the HVA regimen three consecutive times, resulting in complete remission. Repeated chest CT examinations revealed progressive regression of pulmonary TB foci, no AFB was detected in the sputum. This AML patient with DNMT3A, FLT3-TKD, and IDH2 mutations and active TB is difficult to treat. It is very necessary for him to administer prompt anti-leukemia treatment under the premise of active anti-TB treatment. The HVA regimen is effective for this patient. Frontiers Media S.A. 2023-06-13 /pmc/articles/PMC10294669/ /pubmed/37384044 http://dx.doi.org/10.3389/fmed.2023.1180757 Text en Copyright © 2023 Ji, Yang, Xu and Xu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Ji, Lin
Yang, Wei
Xu, Xiao-feng
Xu, Ya-qing
A case report of complete remission of acute myeloid leukemia combined with DNMT3A, FLT3-TKD, and IDH2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine
title A case report of complete remission of acute myeloid leukemia combined with DNMT3A, FLT3-TKD, and IDH2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine
title_full A case report of complete remission of acute myeloid leukemia combined with DNMT3A, FLT3-TKD, and IDH2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine
title_fullStr A case report of complete remission of acute myeloid leukemia combined with DNMT3A, FLT3-TKD, and IDH2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine
title_full_unstemmed A case report of complete remission of acute myeloid leukemia combined with DNMT3A, FLT3-TKD, and IDH2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine
title_short A case report of complete remission of acute myeloid leukemia combined with DNMT3A, FLT3-TKD, and IDH2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine
title_sort case report of complete remission of acute myeloid leukemia combined with dnmt3a, flt3-tkd, and idh2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10294669/
https://www.ncbi.nlm.nih.gov/pubmed/37384044
http://dx.doi.org/10.3389/fmed.2023.1180757
work_keys_str_mv AT jilin acasereportofcompleteremissionofacutemyeloidleukemiacombinedwithdnmt3aflt3tkdandidh2genemutationsandactivepulmonarytuberculosistreatedwithhomeharringtoninevenetoclaxazacytidine
AT yangwei acasereportofcompleteremissionofacutemyeloidleukemiacombinedwithdnmt3aflt3tkdandidh2genemutationsandactivepulmonarytuberculosistreatedwithhomeharringtoninevenetoclaxazacytidine
AT xuxiaofeng acasereportofcompleteremissionofacutemyeloidleukemiacombinedwithdnmt3aflt3tkdandidh2genemutationsandactivepulmonarytuberculosistreatedwithhomeharringtoninevenetoclaxazacytidine
AT xuyaqing acasereportofcompleteremissionofacutemyeloidleukemiacombinedwithdnmt3aflt3tkdandidh2genemutationsandactivepulmonarytuberculosistreatedwithhomeharringtoninevenetoclaxazacytidine
AT jilin casereportofcompleteremissionofacutemyeloidleukemiacombinedwithdnmt3aflt3tkdandidh2genemutationsandactivepulmonarytuberculosistreatedwithhomeharringtoninevenetoclaxazacytidine
AT yangwei casereportofcompleteremissionofacutemyeloidleukemiacombinedwithdnmt3aflt3tkdandidh2genemutationsandactivepulmonarytuberculosistreatedwithhomeharringtoninevenetoclaxazacytidine
AT xuxiaofeng casereportofcompleteremissionofacutemyeloidleukemiacombinedwithdnmt3aflt3tkdandidh2genemutationsandactivepulmonarytuberculosistreatedwithhomeharringtoninevenetoclaxazacytidine
AT xuyaqing casereportofcompleteremissionofacutemyeloidleukemiacombinedwithdnmt3aflt3tkdandidh2genemutationsandactivepulmonarytuberculosistreatedwithhomeharringtoninevenetoclaxazacytidine