ACUTE PROMYELOCYTIC LEUKEMIA WITH LOW GRADE FOLLICULAR B NON HODGKIN
POSTER 11
LYMPHOMA : CASE PRESENTATION.
Mohamed Elbahoty1, Ayman Youssef2, Mohamed Elshazly1 and Ashraf Elghandour3
(1)Alexandria faculty of medicine, hematology unit, internal medicine department, Alexandria, Egypt
(2)Bone marrow transplantation unit, Alexandria university, Alexandria, Egypt
(3)Vice dean of postgraduate affairs, Alexandria faculty of medicine, Alexandria, Egypt
Objectives:
1. Describe the challenging conditions in which the hematologist faces two morphologically
distinct clones at the same time.
2. Establish a pathogenetic links between the different disease processes.
3. Suggest a molecular work up and a risk stratification for these cases.
4. Suggest a treating regimen that may target one or both disease processes.
Subjects and results :
A 55 year old man presented to the outpatient hematology clinic with extertional dyspnea, headache
and B symptoms (low grade fever, night sweats and weight loss). He was pale with multiple enlarged
firm and non tender generalized lymphadenopathy together with splenomegaly. Initial CBC has
shown Hb 85 g/L, platelets 95000/ml and WBC 5400/ml. His liver and kidney functions were within
the reference values except for elevated uric acid level 9 mg/dl. At this time the patient had negative
virology, normal LDH and coagulation profile.He has done a LN biopsy that showed histopathological
and immunohistochemical features of follicular B-Non Hodgkin Lymphoma (NHL)with positive CD20,
CD10, CD79a, BCL2, CD23 and negative for CD15, CD30. At this time no bone marrow examination
was done. The lost follow up and returned back with severe chest infection, Hb 67 g/L, platelets
52000/ml and WBC 14000 then two days later he deteriorated with acute kidney injury and pleural
effusion. There was progressive increase in INR 1.8 and D-dimer 96000 mic/L, pleural tapping and
analysis yielded lymphocytes rich fluid. Bone marrow examination showed two populations of cells;
the dominant population of myeloblasts and promyelocytes positive for CD45(dim), CD13, CD33,
CD11c and a second population of B lymphocytes positive for CD22, CD79a(weak), CD19, CD10, CD37
and strong Lambda light chain, however negative for CD23, CD5 and FMC7. The patient tested
positive for PML-RARA re-arrangement. The patient has received supportive transfusion and
antibiotics however he unfortunately died from severe sepsis and hemorrhage.
Results : This is a case of double hematologic malignancies representing follicular B NHL and acute
promyelocytic leukemia. This patient was unfortunate as he has not received an induction
chemotherapy that could have altered the disease progress.
Discussion : Double hematologic malignancies are very challenging situations for both the patient
and the physician as the diagnosis may not be clear and no widely approved consensus for its
treatment adding to this the markedly increased mortality early at presentation. This requires further
genetic and molecular studies that can define the different mechanisms behind it occurrence plus
proposing treatment protocols that can target both.
SCIENTIFIC
PROGRAMME
RARE SUBSETS OF
ACUTE LEUKAEMIA
TRACKING LEUKAEMIC
STEM CELLS (LSCs)
ROUTINE DIAGNOSIS
GENE EXPRESSION
AND MUTATIONAL
PROFILING
DEBATE 1 – ALL
PATIENTS WITH
INTERMEDIATE-RISK
AML MUST BE
TRANSPLANTED
INTERACTIVE
CASES 1 – MUTATION-BASED
THERAPY
OFF-LABEL
ROUNDTABLE –
SHOULD WE REALLY
USE NEW TARGETED
INHIBITORS AS SINGLE
AGENTS ?
ADDITION OF A 3RD
AGENT TO FRONTLINE
7+3
ROUNDTABLE –
CURATIVE OPTIONS
FOR OLDER AML
INTERACTIVE CASES 2
DEBATE 2 - BEST
TREATMENT FOR
NPM1-MUTATED AML IN
THE NEXT FUTURE ?
ALLOGENEIC
HAEMATOPOIETIC
STEM CELL
TRANSPLANTATION
(HSCT)
IMMUNOTHERAPY FOR
ACUTE LEUKAEMIA
DEBATE 3 - T-ALL:
WHERE ARE WE GOING
NOW?
SELECTED ABSTRACTS
AND CLINICAL
CASES FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES