Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
J Med Case Rep. 2023 Sep 5;17(1):398. doi: 10.1186/s13256-023-04126-2.
Acute myeloid leukemia is a rare event in post-liver-transplantation recipients. In the present report, we described a case of extramedullary acute myeloid leukemia, M/M subtype, following orthotopic liver transplant.
The patient was a 50-year-old Iranian woman who underwent orthotopic liver transplant due to hepatitis B-related cirrhosis (Child C, MELD (model for end-stage liver disease score) = 22). Orthotopic liver transplant was performed using the piggy back technique in January 2022. Induction immunosuppressive therapy was 1 gm methylprednisolone for 3 days followed by a triple maintenance immunosuppressive regimen including mycophenolate mofetil, prednisolone, and tacrolimus. About 5 months after orthotopic liver transplant in June 2022, the patient presented with leukocytosis, with white blood cell count of 99.4 × 103/µl, and physical examination revealed only cervical lymphadenopathy. Biopsy of cervical lymph nodes showed a myeloid tumor. She was immediately hospitalized. Eight hours after hospitalization, the patient gradually developed lethargy and decreased O saturation to approximately 89%. Flow cytometry demonstrated the markers of a myelomonocytic acute myeloid leukemia (M/M). Cytoreduction was immediately started by intensive leukopheresis followed by induction therapy. Because of a septic complication during the induction therapy, further chemotherapy was discontinued and broad-spectrum antibiotics and antifungal treatments started. Unfortunately, our patient died of severe septic shock 42 days after hospitalization.
Acute myeloid leukemia is a rare phenomenon after liver transplantation, and it can follow a rapidly fatal clinical course.
急性髓细胞白血病在肝移植后受体中较为罕见。在本报告中，我们描述了一例肝移植后发生的骨髓外急性髓细胞白血病，M/M 亚型。
患者为 50 岁伊朗女性，因乙型肝炎相关肝硬化（Child C，MELD 评分=22）接受原位肝移植。2022 年 1 月采用背驮式技术进行原位肝移植。诱导性免疫抑制治疗方案为连续 3 天给予 1 克甲基强的松龙，然后采用三联维持性免疫抑制方案，包括霉酚酸酯、泼尼松和他克莫司。2022 年 6 月，肝移植后约 5 个月，患者出现白细胞增多，白细胞计数为 99.4×103/µl，体检仅发现颈淋巴结肿大。颈淋巴结活检显示髓样肿瘤。她立即住院。住院 8 小时后，患者逐渐出现嗜睡和 O 饱和度下降至约 89%。流式细胞术显示出一个骨髓单核细胞性急性髓细胞白血病（M/M）的标志物。立即通过密集白细胞去除术开始减少细胞数量，随后进行诱导治疗。由于在诱导治疗期间发生感染性并发症，进一步的化疗被停止，并开始使用广谱抗生素和抗真菌治疗。不幸的是，我们的患者在住院后 42 天因严重感染性休克死亡。
急性髓细胞白血病在肝移植后较为罕见，且可能具有快速致命的临床病程。
