Haemophagocytic lymphohistiocytosis occurred during induction chemotherapy in an acute monocytic leukemia patient with FLT3-ITD and DNMT3A mutations.

Abstract

BACKGROUND:

Haemophagocytic lymphohistiocytosis (HLH) is considered to be a large challenge for clinicians due to the variable overlaps of symptoms with other severe diseases and a high rate of mortality. Prompt diagnosis and treatment are crucial to avoid a fatal outcome. However, very limited reports have focused on HLH during chemotherapy (Ch-HLH) due to a low incidence and insufficient knowledge.

CASE PRESENTATION:

A 22-year-old male was diagnosed with acute monocytic leukemia with FLT3-ITD and DNMT3A mutations and pulmonary infection. He received IA regimen (Idarubicin, 8 mg/m2/d for 3 days and cytarabine, 100 mg/m2/d for 7 days) chemotherapy, anti-infection drugs and blood components transfusions. During the stage of bone marrow suppression, he presented with a fever, cytopenia (WBC, 0.43 × 109/L; Hb, 73 g/L and PLT, 1 × 109/L), refractory coagulation dysfunction (APTT, 104.0 s; PT, 30.5 s and Fbg, 0.87 g/L), splenomegaly (3 cm below the costal margin), hyperferritinemia (SF > 3000 μg/L), increased soluble interleukin-II receptors (sIL-2R > 7500 u/mL) and haemophagocytosis in the bone marrow and was diagnosed with HLH. After he was treated with methylprednisolone at 500 mg/d for 3 days, 120 mg/d for 3 days and 80 mg/d for 3 days, followed by a gradually reduced dose combined with powerful anti-infection drugs, his symptoms subsided and his abnormal parameters recovered to normal levels.

CONCLUSION:

Patients with HLH in acute leukemia have a high rate of mortality. This case report provides helpful clinical experiences relative to the recognition and treatment of Ch-HLH for clinicians.

• Authors: Fei Li, Xiaojie Zhang, Yunyun Wang, Ailin Yang, Zhanglin Zhang, Weiping Tang, Nan Zhong, Huidong Shi
• Journal: BMC cancer (BMC Cancer) Vol. 18 Issue 1 Pg. 604 (May 29 2018) ISSN: 1471-2407 [Electronic] England
• PMID: 29843647 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Infective Agents
• DNMT3A protein, human
• DNA (Cytosine-5-)-Methyltransferases
• DNA Methyltransferase 3A
• FLT3 protein, human
• fms-Like Tyrosine Kinase 3
• Methylprednisolone

Topics

• Adult
• Anti-Infective Agents (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Bone Marrow (drug effects)
• DNA (Cytosine-5-)-Methyltransferases (genetics)
• DNA Methyltransferase 3A
• Humans
• Induction Chemotherapy (adverse effects)
• Leukemia, Monocytic, Acute (drug therapy, genetics)
• Lymphohistiocytosis, Hemophagocytic (blood, chemically induced, diagnosis, drug therapy)
• Male
• Methylprednisolone (therapeutic use)
• Mutation
• Tandem Repeat Sequences (genetics)
• Treatment Outcome
• Young Adult
• fms-Like Tyrosine Kinase 3 (genetics)