Open AccessAcute myeloid leukemia with cup-like blasts and FLT3-ITD and NPM1 mutations mimics features of acute promyelocytic leukemia: a case of durable remission after sorafenib and low-dose cytarabine
Author(s) -
Jie Sun,
Ning Shen,
Feng Ren,
Jiangtao Li,
Ting Wang,
Baoli Xing,
Xiaoquan Zhu,
Yanyang Zhao,
Lei Pei,
Hui Liu
Publication year - 2021
Publication title -
anti-cancer drugs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.651
H-Index - 93
eISSN - 1473-5741
pISSN - 0959-4973
DOI - 10.1097/cad.0000000000001228
Subject(s) - cytarabine , medicine , acute promyelocytic leukemia , sorafenib , npm1 , myeloid leukemia , aclarubicin , leukemia , oncology , acute megakaryoblastic leukemia , cancer research , biology , karyotype , retinoic acid , biochemistry , hepatocellular carcinoma , chromosome , gene
Some previous researches raised the possibility of a novel acute myeloid leukemia (AML) entity presenting cup-like cytomorphology with mutations of both FLT3 and NPM1 or one of them. However, the clinical implications of this subtype remain unknown. We describe a 63-year-old patient belonging to this distinct AML subtype, who presented similar features of acute promyelocytic leukemia (APL) including nuclear morphology, negative for CD34 and HLA-DR, and abnormal coagulation. He had no response to both arsenic trioxide and CAG regimen (cytarabine, aclarubicin, and G-CSF). Given that the patient carried the FLT3-ITD mutation, we switched to a pilot treatment of FLT3 inhibitor sorafenib combined with low-dose cytarabine (LDAC). To date, the patient achieved durable complete remission over 58 months. These findings suggest that AML with cup-like blasts and FLT3-ITD and NPM1 mutations mimic APL, and the prognosis of this subtype may be improved by sorafenib combined with LDAC.