A Favorable Outcome With CPX-351 Liposome (Vyxeos) in the Management of A Sporadic Monosomy 7 Myelodysplastic Syndrome Related Acute Myeloid Leukemia

Abstract

Introduction: Although Acute Myeloid Leukemia (AML) has been associated with several environmental factors, in some patients the evolution to AML is preceded by myelodysplastic syndrome (MDS). We report a case of 63-year-old male who was diagnosed with sporadic monosomy 7 MDS/AML who achieved good response to treatment with CPX-351 (Vyxeos) induction chemotherapy. Case information: A 63-year-old male initially presented to the ED for further evaluation of pancytopenia that was discovered incidentally during a routine office visit. Further evaluation revealed his blast count was elevated with presence of Auer rods, myelocytes and basophilia. He was admitted for further work-up of pancytopenia with suspicion being for MDS/AML and bone marrow biopsy for flow cytometric evaluation of the bone marrow was strongly suggestive of acute myeloid leukemia, with morphology suggesting a predisposing MDS. Subsequent molecular cytogenetic [FISH] report confirmed -7/7q abnormality in 80% of nuclei with loss of 1 copy of chromosome 7. The following week, patient was initiated on CPX–351 [Vyxeos; daunorubicin and cytarabine liposome for injection]. Bone marrow biopsy following induction chemotherapy showed 11 to 12% of CD34 positive myeloid blasts with abnormal myeloid maturation, representing notable improvement with greater than 50% reduction in his blast count. Conclusion: Sporadic monosomy 7 MDS/AML that arises without evidence of germline genetic predisposition and in the absence of other predisposing medical conditions or treatments is an uncommon subset of AML. Vyxeos induction chemotherapy may be an excellent option in the management of sporadic monosomy 7 MDS/AML.