Therapeutic Challenges and Emerging Strategies for and Mutations in a -Positive Myeloproliferative Neoplasm: A Case Report.

Myeloproliferative neoplasm (MPN) with eosinophilia associated with is a rare eosinophilic disorder typically treated with imatinib. However, resistance due to the T674I mutation poses a significant challenge. This case presents the first reported instance of concurrent and (p.E76D) mutations in a 38-year-old male patient with MPN and eosinophilia. The patient initially responded to imatinib but developed resistance after ten months, leading to severe spinal cord compression caused by granulocytic sarcoma. Despite undergoing radiotherapy, chemotherapy, and allogeneic hematopoietic stem cell transplantation (allo-HSCT), the disease progressed. Although full donor chimerism was achieved post-transplant, the patient relapsed shortly afterward with eosinophilia, splenomegaly, and constitutional symptoms. Further treatments, including sorafenib and decitabine, failed to control the disease, and the patient ultimately died from multiorgan failure. This case illustrates the therapeutic challenges associated with -positive eosinophilic disorder, especially when compounded by the mutation. Resistance to standard treatments underscores the urgent need for novel therapies to manage this rare and aggressive disease.