Prolonged Survival of a 79-Year Old Man with Acute Myeloid Leukemia M2, Normal Karyotype, NPM1 and FLT3-ITD Mutations, WBC 33.7 × 109/L, and Involving only Granulocyte-Macrophage Line on 53 Cycles of Low-Dose Cytarabine

Abstract

The prognosis of older patients with de novo Acute Myeloid Leukemia (AML) is usually dismal. Palliative therapy with LDAC is one of the treatment options with a median survival of less than one year. Several reported older cases with AML with a survival of 25-51 months on therapy with LDAC lack details of the AML type, clinical characteristics, and treatment. This case report describes a 79-year old man with AML M2, normal karyotype, leukocytosis 33.7 x 10 9 /L, and involving only Granulocyte-Macrophage Line (GM-AML) who survived 84 months on 53 repeated cycles of LDAC, the longest described survival on LDAC. His leukemic cells exhibited Nucleophosmin 1 ( NPM1 ) mutation and Fms-Like Tyrosine-kinase 3 gene ( FLT3 ) Internal Tandem Duplication (ITD) with a high FLT3 -ITD to FLT3 WT allelic ratio, typical immunophenotype, morphology and no dysplastic features. We propose that older patients with de novo GM-AML with these characteristics may benefit from prolonged LDAC therapy. Changes; EMD: Erythroblastic and/or Megakaryocytic Dysplasia; BM: Bone Marrow; FBC: Full Blood Cell count; FLT3- ITD: Fms-like Tyrosine kinase-3 gene ( FLT3 ) Internal Tandem Duplication (ITD); FLT3 WT: FLT3 Wild Type; GM-AML: AML involving only cells of Granulocytic-Macrophage line; CR: Complete Remission; HC: Hydroxycarbamide; LDAC: Low-Dose Cytarabine; NK: normal karyotype; NPM1 : Nucleophosmin 1 gene; PML/RARA : Fusion gene of Promyelocytic Leukemia gene/Retinoic Acid Receptor-Alpha gene; PS: Performance Status; RBC: Red Blood Cells; SICT: Standard-Dose Induction Chemotherapy; WBC: White Blood Cells