Xu Huiping, She Qunqing, Xie Linjun
The First Hospital of Putian City, Putian, China.
The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
Front Oncol. 2025 Aug 6;15:1620271. doi: 10.3389/fonc.2025.1620271. eCollection 2025.
We report the case of a 78-year-old male who was diagnosed with -positive acute monocytic leukemia (AML-M5), complicated by leukemic hepatic infiltration and cholestatic liver injury. Initial management included hydroxyurea and liver-protective therapies; however, liver dysfunction progressed despite treatment. With the patient's liver function deteriorating, chemotherapy with venetoclax and azacitidine was initiated under close monitoring, along with intensive supportive care including methylprednisolone. This regimen choice was based on a careful assessment of the hepatotoxicity profiles of these drugs in conjunction with the patient's hepatic function. As the leukemic burden decreased, liver function gradually improved, and the patient achieved hematologic recovery sufficient for discharge. This case highlights the challenges of treating elderly AML-M5 patients with hepatic infiltration and emphasizes the importance of early recognition and individualized treatment strategies and the potential benefits of dose-adjusted induction therapy tailored according to the hepatotoxicity profiles of the drugs and the patient's hepatic function.
我们报告了一例78岁男性患者，其被诊断为阳性急性单核细胞白血病（AML-M5），并发白血病肝脏浸润和胆汁淤积性肝损伤。初始治疗包括羟基脲和肝脏保护疗法；然而，尽管进行了治疗，肝功能仍持续恶化。随着患者肝功能恶化，在密切监测下开始使用维奈克拉和阿扎胞苷进行化疗，并给予包括甲泼尼龙在内的强化支持治疗。这种方案的选择是基于对这些药物肝毒性特征以及患者肝功能的仔细评估。随着白血病负担减轻，肝功能逐渐改善，患者实现了足以出院的血液学缓解。该病例突出了治疗伴有肝脏浸润的老年AML-M5患者的挑战，并强调了早期识别、个体化治疗策略的重要性，以及根据药物肝毒性特征和患者肝功能调整剂量的诱导治疗的潜在益处。
