Acute Myeloid Leukemia Presenting Research Articles

Atypical Acute Myeloid Leukemia Presentation: Spinal Metastasis and Neurogenic Bladder

Atypical Acute Myeloid Leukemia Presentation: Spinal Metastasis and Neurogenic Bladder

Immune Thrombocytopenic Purpura (ITP) as a Rare Presentation of Acute Myeloid Leukemia (AML): A Case Report

Immune Thrombocytopenic Purpura (ITP) as a Rare Presentation of Acute Myeloid Leukemia (AML): A Case Report

AML-354 Immune Thrombocytopenic Purpura (ITP) as a Rare Presentation of Acute Myeloid Leukemia (AML): A Case Report

AML-354 Immune Thrombocytopenic Purpura (ITP) as a Rare Presentation of Acute Myeloid Leukemia (AML): A Case Report

Myeloid sarcoma: Experience from a tertiary care center in southern India - A series of eight unusual cases.

Myeloid sarcoma (MS) is a tumor mass comprising myeloid blasts with or without maturation occurring in any site other than bone marrow. It is a rare and distinct clinical presentation of myeloid neoplasm. This is a retrospective study over 7 years (2015-2022) comprising a series of eight cases, which includes clinical details, morphology, immunohistochemistry (IHC) markers, cytogenetics, and molecular details. These cases showed up as an isolated MS (3/8), as an initial clinical presentation in acute myeloid leukemia (1/8), as acute myeloid leukemia (1/8), as a disease progression in primary myelofibrosis (1/8), as chronic myeloid leukemia (1/8), and as BCR-ABL-negative myelodysplastic syndrome/myeloproliferative neoplasm (1/8). One of the three isolated MS was incorrectly identified as having Ewing's sarcoma. One case each presented at the cervical lymph node, mediastinum, skin, sacral soft tissue, maxillary sinus, and perinephric fat, and two cases presented at the hard palate. Four of the cases in our study were clinically thought of as lymphoma/sarcoma, which was a major diagnostic challenge. All but one case succumbed to their disease. Without adequate clinical history and appropriate use of ancillary techniques such as IHC in tissue biopsies, flow cytometry, cytogenetics, and molecular studies, these cases have a high chance of being misdiagnosed as non-Hodgkin lymphoma, small round blue cell tumor, or undifferentiated carcinomas, which can complicate patient management and prognosis.

Activation of non-classical Wnt signaling pathway effectively enhances HLA-A presentation in acute myeloid leukemia.

The escape from T cell-mediated immune surveillance is an important cause of death for patients with acute myeloid leukemia (AML). This study aims to identify clonal heterogeneity in leukemia progenitor cells and explore molecular or signaling pathways associated with AML immune escape. Single-cell RNA sequencing (scRNA-seq) was performed to identified AML-related cellular subsets, and intercellular communication was analyzed to investigate molecular mechanisms associated with AML immune escape. Bulk RNA sequencing (RNA-seq) was performed to screen differentially expressed genes (DEGs) related to hematopoietic stem cell progenitors (HSC-Prog) in AML, and critical ore signaling pathways and hub genes were found by Gene Set Enrichment Analysis (GSEA), Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. The mRNA level of the hub gene was verified using quantitative real-time PCR (qRT-PCR) and the protein level of human leukocyte antigen A (HLA-A) using enzyme-linked immuno sorbent assay (ELISA). scRNA-seq analysis revealed a large heterogeneity of HSC-Prog across samples, and the intercellular communication analysis indicated a strong association between HSC-Prog and CD8+-T cells, and HSC-Prog also had an association with HLA-A. Transcriptome analysis identified 1748 DEGs, enrichment analysis results showed that non-classical wnt signaling pathway was associated with AML, and 4 pathway-related genes (RHOA, RYK, CSNK1D, NLK) were obtained. After qRT-PCR and ELISA validation, hub genes and HLA-A were found to be down-regulated in AML and up-regulated after activation of the non-classical Wnt signaling pathway. In this study, clonal heterogeneity of HSC-Prog cells in AML was identified, non-classical wnt signaling pathways associated with AML were identified, and it was verified that HLA-A could be upregulated by activation of non-classical wnt signaling, thereby increasing antigen presentation.

Case report: Clinical features of pediatric acute myeloid leukemia presenting with cardiac tamponade: a case series study and literature review

Case report: Clinical features of pediatric acute myeloid leukemia presenting with cardiac tamponade: a case series study and literature review

A propensity score–matched comparison of cytoreductive strategies in patients with acute myeloid leukemia presenting with hyperleukocytosis.

e18509 Background: Hyperleukocytosis (white blood cell (WBC) count greater than 100x109), which may lead to the clinical entity of leukostasis, is a hematologic emergency present at diagnosis in 18% of patients with acute myeloid leukemia (AML). There is controversy regarding the appropriate cytoreductive strategy, which may include cytoreductive chemotherapy, hydroxyurea, and/or leukapheresis. The American society for apheresis (ASFA) released guidelines in 2023 making leukapheresis a Category III recommendation, however significant heterogeneity and methodologic flaws exist in the evidence used to make these recommendations. Methods: Retrospective analysis of 58 patients at Massey Comprehensive Cancer Center between 2017 and 2023 who received either hydroxyurea alone (n=35) or both hydroxyurea and leukapheresis (n=23) for hyperleukocytosis at time of presentation for AML diagnosis was performed. Baseline characteristics including age, sex, Charlson Comorbidity Index (CCI), European LeukemiaNet (ELN) risk stratification, and WBC count prior to cytoreduction were collected. Comparisons of complete remission rates (CR/CRi), 30- and 60-day mortality, median overall survival (OS), and rates of therapy-induced tumor lysis syndrome (TLS) and disseminated intravascular coagulation (DIC) were analyzed using Kaplan-Meier, Fisher’s exact, Mann-Whitney tests, respectively on a propensity score matched cohort to account for differing initial WBC counts between the treatment groups. Results: PSM was used to match presenting WBC counts between the two cohorts. Other baseline characteristics including median age (65y v. 60y), median CCI (5 v. 4), ELN adverse risk rate (31.53% v. 26.1%) did not differ after PSM. No significant difference was found between the hydroxyurea group compared to the hydroxyurea and leukapheresis group, respectively, when analyzing for rate of CR/CRi (36.5% v. 43.5%), 30-day mortality (10.5% v. 17.3%), 60-day mortality (10.5% v. 34.8%), median OS (7.77 mo. v. 8.07 mo.), or rates of DIC (10.5% vs. 8.7%) and therapy induced TLS (0% v. 0%). Conclusions: Patients who received hydroxyurea alone had similar outcomes when compared to the combined treatment group with respect to median OS, CR/CRi, and mortality rates. These results are notable given that leukapheresis is not available at many medical centers and is a resource-heavy procedure, and especially so in light of new ASFA guideline changes. However, these results reflect the laboratory entity of hyperleukocytosis rather than the clinical entity of leukostasis. Further work is ongoing to assess impact of cytoreductive strategies in leukostasis in AML, and among different cytogenetic and molecular subtypes. Decisions for leukapheresis or other cytoreductive strategies should be made on a case-by-case decision at an experienced center when possible.

Breast granulocytic sarcoma: a rare presentation of acute myeloid leukemia - a case report

Background: Breast extramedullary myeloid sarcoma is a rare tumor that represents 0.12% of all acute myeloid leukemia cases. Diagnosis can be a real challenge due to the non-specific clinical and radiological features. Reported case: We report a case of a 25-year-old woman who had a painful breast lump. Breast ultrasound revealed an irregular bilateral suspicious mass, and the biopsy confirmed the diagnosis of breast granulocytic sarcoma (GS). The evolution was marked by a dorsal spinal cord compression. A chemotherapy was indicated but refused by the patient. The patient was finally treated with palliative radiotherapy, and chemotherapy. Conclusion: Breast myeloid sarcoma is a rare entity with symptoms reminiscent of those of primary breast cancer making its diagnosis so difficult. Treatment typically involves surgery, chemotherapy, and radiotherapy. Although the poor prognosis of breast GS, detecting the signaling pathways associated with myeloid cell migration to extra-medullary tissues may improve outcomes in the future.

Metastatic Acute Myeloid Leukemia Presenting as Foot Drop: A Rare Neurological Manifestation (P11-11.018)

Metastatic Acute Myeloid Leukemia Presenting as Foot Drop: A Rare Neurological Manifestation (P11-11.018)

Metachronous or Synchronous Presentation of Acute Myeloid Leukemia and Lung Cancer: A Single Center Experience

Aims: Acute myeloid leukemia (AML) is the most common type of leukemia in adults. Lung cancer is one of the most common types of cancer. The concomitant presentation of AML and lung cancer is extremely rare. This study aimed to report a case series of concomitant presentation of acute myeloid leukemia and lung cancer as metachronous or synchronous. Methods: We describe 6 cases with diagnosis of these two diseases in between years of 2016-2020 in our hospital. Patients treated in our hospital were retrospectively reviewed. Clinical characteristics, immunohistochemical and genetic findings, treatments and outcomes were collected. Results: All 6 cases that made up our series had a smoking history. Case 2 had radiotherapy, and it was cranial radiotherapy for prophylaxis. Radiotherapy was also given to case 3 for lung cancer. The other cases had no history of radiotherapy before the diagnosis of AML. We detected lung cancer as metachronous in cases 2, 3, 4, and 5; and synchronously in cases 1 and 6. Conclusion: Coexistence of AML and lung cancer is extremely rare. However, it should be kept in mind that we may encounter these two malignancies in a patient at the same time.

Acute Myeloid Leukaemia Presenting with Cardiac Tamponade: A Case Report and Review of the Literature

Acute Myeloid Leukaemia Presenting with Cardiac Tamponade: A Case Report and Review of the Literature

Approach to a Child with Bilateral Proptosis as a Rare Presentation of Acute Myeloid Leukemia

A 6-year-old girl presented with a 2-month history of sudden onset, painless, progressively increasing bilateral proptosis, palpable lymphadenopathy and skin pallor. A full blood count showed bicytopenia and the erythrocyte sedimentation rate (ESR) was raised. Computerized tomography (CT) scan showed bilateral lacrimal gland enlargement. The bone marrow biopsy was consistent with M2 acute myeloid leukemia (AML). The patient received symptomatic treatment and was sent to pediatric oncologist for induction chemotherapy and tumor lysis syndrome (TLS) protocol. Bilateral proptosis is a rare manifestation of several diseases. This case report emphasizes on the low threshold for hematological malignancies in the presentation of bilateral proptosis. Ophthalmologists should be cognizant of the unusual ophthalmic manifestations of haematological malignancies, as they are a diagnostic challenge but knowledge about the rare extramedullary manifestations of AML facilitates early diagnosis and thereby improves prognosis.
 Categories: Ophthalmology, Pediatrics, Hematology

S4182 A Hard Finding to Stomach: Recurrent Acute Myeloid Leukemia Presenting as Gastric Outlet Obstruction

S4182 A Hard Finding to Stomach: Recurrent Acute Myeloid Leukemia Presenting as Gastric Outlet Obstruction

AML-220 Sinusitis as a Presentation of Acute Myeloid Leukemia (AML) and Myeloid Sarcoma (MS)

AML-220 Sinusitis as a Presentation of Acute Myeloid Leukemia (AML) and Myeloid Sarcoma (MS)

POSTER: AML-220 Sinusitis as a Presentation of Acute Myeloid Leukemia (AML) and Myeloid Sarcoma (MS)

POSTER: AML-220 Sinusitis as a Presentation of Acute Myeloid Leukemia (AML) and Myeloid Sarcoma (MS)

Unusual Presentation of Concurrent Cutaneous Plasmablastic Lymphoma and Acute Myeloid Leukemia: a Case Report and a Comprehensive Review

Unusual Presentation of Concurrent Cutaneous Plasmablastic Lymphoma and Acute Myeloid Leukemia: a Case Report and a Comprehensive Review

Hyperleukocytosis in patients with acute myeloid leukemia admitted to the intensive care unit: a single-center retrospective analysis

A relevant proportion of patients with acute myeloid leukemia (AML) presenting with hyperleukocytosis are admitted to the intensive care unit (ICU). However, data on characteristics and outcomes of these patients are limited. We therefore conducted a single-center retrospective analysis including 69 consecutive AML patients with a white blood cell (WBC) count > 100.000/µl who had been treated on the ICU between 2011 and 2020. The median age was 63 years (range: 14–87 years). Males accounted for the majority of cases (n = 43; 62.3%). Mechanical ventilation (MV), renal replacement therapy and the use of vasopressors were necessary in 34.8%, 8.7% and 40.6% of patients, respectively. Cardiopulmonary resuscitation was performed in 15.9% of patients. The ICU, hospital, 90-day and 1-year survival rates were 53.6%, 43.5%, 42% and 30.4%, respectively. Age (p = 0.002), SOFA score (p < 0.001) and MV (p < 0.001) were independently associated with a reduced survival probability. A score comprising the factors age > 70 years, lactate dehydrogenase level > 1500 U/l, WBC count > 150.000/µl, elevated lactate level and SOFA score > 7 allowed the discrimination of 3 distinct risk groups (low-risk: 0–1 points, intermediate-risk: 2 points, high-risk: 3–5 points) with regard to survival (p < 0.0001). Taken together, the present analysis indicates that more than two-thirds of AML patients with hyperleukocytosis treated on the ICU die within 1 year. However, outcomes vary considerably depending on the presence of risk factors.

Intracranial myeloid sarcoma as the first presentation of acute myeloid leukemia and literature review.

Intracranial myeloid sarcoma is a rare extramedullary presentation of acute myeloid leukemia (AML). Itcan involve the meninges and ependyma presenting as extra-axial mass lesion. Rarely, it can also invade the brainparenchyma. It is commonly seen in children. It is usually misdiagnosed due to its close resemblance to otherintracranial tumors (meningioma, metastasis, Ewing's sarcomas, and lymphoma). These are underdiagnosed ifthey precede the diagnosis of leukemia. A 7-year-old boy with isolated intracranial myeloid sarcoma who presented with raised intracranialpressure (ICP) which was successfully managed by surgical excision. Isolated intracranial myeloid sarcoma is a rare presentation of AML. Leukemia can be diagnosed earlyduring the postoperative period and can be started on therapy timely. These patients requires regular follow-ups(clinical, laboratory and radiological) to detect relapses early.

Isolated CNS Relapse in Favourable Acute Myeloid Leukemia Presenting as Cerebello-Pontine Angle Tumor

Isolated CNS Relapse in Favourable Acute Myeloid Leukemia Presenting as Cerebello-Pontine Angle Tumor

An Update on FLT3 in Acute Myeloid Leukemia: Pathophysiology and Therapeutic Landscape.

This review aims to summarize the pathophysiology, clinical presentation, and management of acute myeloid leukemia (AML) with FMS-like tyrosine kinase-3 (FLT3) mutations. The recent European Leukemia Net (ELN2022) recommendations re-classified AML with FLT3 internal tandem duplications (FLT3-ITD) as intermediate risk regardless of Nucleophosmin 1 (NPM1) co-mutation or the FLT3 allelic ratio. Allogeneic hematopoietic cell transplantation (alloHCT) is now recommended for all eligible patients with FLT3-ITD AML. This review outlines the role of FLT3 inhibitors in induction and consolidation, as well as for post-alloHCT maintenance. It outlines the unique challenges and advantages of assessing FLT3 measurable residual disease (MRD) and discusses the pre-clinical basis for the combination of FLT3 and menin inhibitors. And, for the older or unfit patient ineligible for upfront intensive chemotherapy, it discusses the recent clinical trials incorporating FLT3 inhibitors into azacytidine- and venetoclax-based regimens. Finally, it proposes a rational sequential approach for integrating FLT3 inhibitors into less intensive regimens, with a focus on improved tolerability in the older and unfit patient population. The management of AML with FLT3 mutation remains a challenge in clinical practice. This review provides an update on the pathophysiology and therapeutic landscape of FLT3 AML, as well as a clinical management framework for managing the older or unfit patient ineligible for intensive chemotherapy.