Abstract
The emergence of coronavirus disease 2019 (COVID-19) has created new challenges in the management of serious diseases. We describe a 41-year-old male who presented with fever, watery diarrhea, and epistaxis. Initial workup revealed pancytopenia with >50% blasts on the peripheral smear raising suspicion of acute myeloid leukemia (AML) (later confirmed by bone marrow biopsy as AML with myelodysplasia-related changes) and a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the extraordinary risk, he was treated with remdesivir and convalescent plasma for COVID-19. On admission day 8, repeat PCR for SARS-CoV-2 returned negative and the patient was deemed stable for chemotherapy. Therefore, induction was done with liposomal daunorubicin and cytarabine. However, he did not respond to the therapy and was started on re-induction therapy with decitabine and venetoclax. In our discussion, we review the current principles of treatment of patients with concurrent COVID-19 and AML.
Highlights
The emergence of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has brought forth new challenges in the management of serious diseases including hematological malignancies
We describe a patient with newly diagnosed acute myeloid leukemia (AML) and COVID-19, and discuss the current approach of management of such cases
The induction for newly diagnosed AML is often done on an emergent basis, a reasonable delay in order to test a symptomatic patient for COVID-19, or to provide appropriate management for the COVID-19 infection may be a prudent approach [6]
Summary
The emergence of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has brought forth new challenges in the management of serious diseases including hematological malignancies. Next-generation sequencing detected a pathogenic frameshift genomic alteration in the TP53 gene (c.636delT; p.R213Dfs*34) Overall, these findings were consistent with AML with myelodysplasia-related changes (AML-MRC), stratified in the poor/adverse risk category given the 5q deletion, complex karyotype, and TP53 mutation. Given the presence of watery diarrhea, possibility of a false negative result and the overall complexity of the case, oral vancomycin, and IV metronidazole were started. He was given one dose of IV bezlotoxumab (1000 mg) to reduce the risk of recurrence of Clostridium difficile infection (CDI). Peripheral blood flow cytometry done 14 days after the induction revealed 55% myeloid blasts suggesting a lack of response to therapy and obviating the need of repeat bone marrow biopsy. Prognosis remains poor overall given the adverse risk AML, unresponsiveness to initial chemotherapy and complications of neutropenia
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