Ji Lin, Yang Wei, Xu Xiao-Feng, Xu Ya-Qing
Department of Oncology and Hematology, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China.
Front Med (Lausanne). 2023 Jun 13;10:1180757. doi: 10.3389/fmed.2023.1180757. eCollection 2023.
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 , and 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.
2022年3月，一名58岁男性因恶心、呕吐入住当地医院。他的血常规显示白细胞增多和贫血。该患者被诊断为急性髓系白血病（AML）-M5b，伴有 、 和 突变，胸部CT显示患有肺结核（TB）。痰中检测到抗酸杆菌（AFB）。患者随后接受异烟肼+利福平+吡嗪酰胺+乙胺丁醇抗结核治疗。4月8日，在连续三次痰涂片阴性后，他被转至我院血液科。他接受了VA（维奈克拉+阿扎胞苷）抗白血病治疗方案，同时还接受左氧氟沙星+异烟肼+吡嗪酰胺+乙胺丁醇抗结核治疗。经过一个疗程的VA治疗后，骨髓未缓解。因此，患者接受了HVA（高三尖杉酯碱+维奈克拉+阿扎胞苷）抗白血病治疗方案。5月25日，骨髓涂片显示原始单核细胞为1%。此外，骨髓流式细胞术显示未发现任何异常细胞。mNGS显示DNMT3A（突变率44.7%），但在FLT3-TKD和IDH2中未检测到突变。患者随后连续三次接受HVA方案治疗，实现完全缓解。多次胸部CT检查显示肺结核病灶逐渐消退，痰中未检测到AFB。这位患有DNMT3A、FLT3-TKD和IDH2突变且活动性结核的AML患者治疗困难。在积极抗结核治疗的前提下及时给予抗白血病治疗对他来说非常必要。HVA方案对该患者有效。
