Malagola M, Polverelli N, Cancelli V, Morello E, Turra A, Borlenghi E, Cattina F, Rambaldi B, Bernardi S, Zanaglio C, Dereli Eke Elif, Gandolfi L, Farina M, Russo D
Chair of Hematology, Department of Clinical and Surgical Sciences, University of Brescia, Bone Marrow Transplant Unit, ASST-Spedali Civili, Brescia, Italy.
Unit of Hematology, ASST-Spedali Civili, Brescia, Italy.
Case Rep Hematol. 2019 Jun 11;2019:3914828. doi: 10.1155/2019/3914828. eCollection 2019.
We present a case of a patient with a three-month history of peripheral blood cytopenia without a confirmed diagnosis of myelodysplastic syndrome, who developed a favourable-risk acute myeloid leukemia (AML), according to the European Leukemia Net (ELN) criteria. The patient achieved a complete remission with incomplete platelet recovery (CRi) after induction. The patient achieved the morphological CR after the first consolidation and completed the first-line treatment with a syngeneic stem cell transplantation (SCT). A disease relapse occurred after one year of CR (blast cell count in the bone marrow 15%), and the patient was offered a haplo-SCT, which he refused due to personal reasons. In this paper, we discuss the interplay between clinical and biological risk factors in non-high-risk AML patients and speculate that some old clinical risk factors (e.g., age of the patient, achievement of CR after induction, and previous history of myelodysplastic syndrome) may still impact on the treatment decision algorithm of some of these patients.
我们报告一例患者，其外周血细胞减少病史长达三个月，未确诊为骨髓增生异常综合征，根据欧洲白血病网（ELN）标准，该患者发展为低危急性髓系白血病（AML）。诱导治疗后，患者达到完全缓解但血小板未完全恢复（CRi）。首次巩固治疗后患者达到形态学完全缓解，并通过同基因干细胞移植（SCT）完成一线治疗。完全缓解一年后疾病复发（骨髓原始细胞计数为15%），患者因个人原因拒绝接受单倍体干细胞移植（haplo-SCT）。在本文中，我们讨论了非高危AML患者临床和生物学危险因素之间的相互作用，并推测一些旧的临床危险因素（如患者年龄、诱导治疗后达到完全缓解以及既往骨髓增生异常综合征病史）可能仍会影响其中一些患者的治疗决策算法。
