Han Qiaoyan, Wu Sheng, Zhang Yefei, Lu Jiao, Jiang Xin, Sun Miao
Department of Hematology, Jingjiang People's Hospital Affiliated to Yangzhou University, Jingjiang, 214500, China.
Department of Pathology, Jingjiang People's Hospital Affiliated to Yangzhou University, Jingjiang, 214500, China.
Heliyon. 2024 Oct 9;10(20):e39144. doi: 10.1016/j.heliyon.2024.e39144. eCollection 2024 Oct 30.
Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML), with myeloid sarcoma (MS) seldom occurring at onset. Myelofibrosis (MF) is a condition characterized by megakaryocytic proliferation and atypia with an array of clinical findings, but MF secondary to APL treatment is extremely rare. MF secondary occurring after treatment of APL with MS as the initial presentation has not been reported.
A 73-year-old male was admitted to our hospital in August 2016, presenting with a pain in his left shoulder, followed by right shoulder and bilateral hip pain. A progressive increase in a mass in the right sternoclavicular joint was also observed. After comprehensive examines, he was diagnosed as APL with MS as the initial manifestation in April 2017. The patient then underwent induction, consolidation, and maintenance therapies until August 2019 and achieved complete remission. However, twice examinations in December 2020 and September 2022 confirmed that MF was present.
This is the first case of MF secondary occurring after treatment of APL with MS. Early recognition of MS in APL patients is crucial for timely intervention and treatment initiation. Meticulous diagnostic work-up and careful monitoring during treatment are necessary to detect potential complications, which may significantly impact the patients' outcome. Also, a comprehensive management approach encompassing induction, consolidation, and maintenance therapies should be adopted to ensure optimal therapeutic responses and reduce the risk of recurrence or treatment-related complications.
急性早幼粒细胞白血病（APL）是急性髓系白血病（AML）的一种亚型，发病时很少发生髓系肉瘤（MS）。骨髓纤维化（MF）是一种以巨核细胞增殖和异型性为特征并伴有一系列临床症状的疾病，但APL治疗继发的MF极为罕见。以MS为首发表现的APL治疗后继发MF尚未见报道。
一名73岁男性于2016年8月入住我院，最初表现为左肩疼痛，随后出现右肩及双侧髋部疼痛。还观察到右胸锁关节肿物逐渐增大。经过全面检查，他于2017年4月被诊断为以MS为首发表现的APL。患者随后接受诱导、巩固和维持治疗，直至2019年8月并实现完全缓解。然而，2020年12月和2022年9月的两次检查证实存在MF。
这是以MS为首发表现的APL治疗后继发MF的首例病例。对APL患者早期识别MS对于及时干预和开始治疗至关重要。治疗期间进行细致的诊断检查和密切监测对于发现可能显著影响患者预后的潜在并发症是必要的。此外，应采用包括诱导、巩固和维持治疗的综合管理方法，以确保获得最佳治疗反应并降低复发或治疗相关并发症的风险。
