Primary Philadelphia chromosome positive acute myeloid leukemia: A case report

Medicine (Baltimore). 2018 Nov;97(44):e12949. doi: 10.1097/MD.0000000000012949.

Abstract

Rationale: Philadelphia chromosome positive acute myeloid leukemia (Ph+ AML) is a rare subtype of AML that is now included as a provisional entity in the 2016 revised WHO classification of myeloid malignancies. However, a clear distinction between de novo Ph+ AML and chronic myeloid leukemia blast crisis is challenging. It is still a matter of debate whether Ph+ AML patients should be treated with chemotherapy or tyrosine kinase inhibitors as first-line therapy.

Patient concerns: We reported here a case of a 46-year-old man who was diagnosed as Ph+ AML. This diagnosis was confirmed by bone marrow pathology and karyotype analysis of 46, XY, t (9; 22). Further examination, molecular genetic analysis showed BCR/ABL1 (p190) without ABL1 kinase domain mutations, and direct evidence demonstrated in AML by flow cytometry.

Diagnosis: The diagnosis of Ph+ AML was made on May 2016 according to morphology, immunology, cytogenetic, and molecular criteria, and multiple organ failure was also diagnosed.

Interventions: The patient was treated with dasatinib as the only medication after experiencing multiple organ failure. Then, he received 2 cycles of chemotherapy with IA (idarubicin 8 mg/m, day 1-3; cytarabine 100 mg/m, day 1-7) in August, 2016.

Outcomes: The patient finally achieved a complete molecular remission.

Lessons: This case study suggests that dasatinib can be a safe and effective treatment for Ph+ AML patients with poor physical condition.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / therapeutic use*
  • Bone Marrow Examination / methods
  • Cytarabine / therapeutic use
  • Dasatinib / therapeutic use*
  • Flow Cytometry
  • Fusion Proteins, bcr-abl / genetics
  • Humans
  • Idarubicin / therapeutic use
  • Karyotype
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / complications
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / diagnosis
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy*
  • Male
  • Middle Aged
  • Multiple Organ Failure / etiology
  • Mutation
  • Philadelphia Chromosome

Substances

  • Antineoplastic Agents
  • Cytarabine
  • Fusion Proteins, bcr-abl
  • Dasatinib
  • Idarubicin