Supportive effect of corticosteroid on bone marrow recovery in FLT3/ITD positive acute myeloid leukemia with trisomy 13

Abstract

Trisomy 13 is a rare chromosomal abnormality mainly observed in patients with FAB M0, and is associated with increased FLT3 expression, characterized by aggressive and inferior outcomes. Herein, we describe a case of FLT3/ITD-positive acute myeloid leukemia with trisomy 13, whose neutropenia and thrombocytopenia were improved by corticosteroids with a decrease in blasts in the peripheral blood without chemotherapy. Only short-term chemotherapy could be administered because of the patient’s poor general condition. In contrast, repeated administration of methylprednisolone pulse therapy followed by high-dose prednisolone was required to control the interstitial pneumonitis. Although appropriate chemotherapy, such as oral administration of FLT inhibitors, could not be administered, a dramatic decrease in blasts and an increase in both neutrophils and platelets were observed. The addition of corticosteroids to chemotherapy is associated with a better clinical course in patients with hyperleukocytic and pediatric acute myeloid leukemia. In the present patient, the peripheral WBC count was not high, the steroids allowed for the recovery of normal hematopoiesis with diminishing blasts. Although stem cell transplantation is necessary to improve overall survival for aggressive acute myeloid leukemia, intensive chemotherapy cannot often be administered in frail older patients. Lower dose of steroids might be able to effectively control acute myeloid leukemia without serious adverse effects, resulting in a better clinical course in frail older patients with acute myeloid leukemia.