From ASH Meeting on Hematologic Malignancies: Treating Patients With AML With Mutations and Minimal Residual Disease

Jessica K. Altman, MD
Associate professor of medicine in hematology and oncology at Robert H. Lurie Medical Research Center in Chicago

During their presentations, MHM speakers will be asking the audience how they would respond to patient cases. Audience members will vote live at the meeting via an audience response system, but we want to know what you would do.

CLINICAL DILEMMA

A 39-year-old male was noted to have anemia in July 2017. Evaluation revealed a vitamin B12 deficiency and his counts normalized within two months of B12 supplementation. In December 2017, he developed dyspnea on exertion and fatigue that he initially attributed to stress. However, his symptoms progressed, and he presented to his primary-care provider in February 2018.

Peripheral blasts were noted and his lab results were as follows:

  • White blood cells 5.56×109/L
  • Hemoglobin 10.4 g/dL
  • Platelets 33×109/L

Bone marrow evaluation revealed AML (30% blasts) involving a normocellular bone marrow with marked erythroid predominance, erythroid dysplasia, and mild granulocytic and megakaryocytic dysplasia. These results raised the possibility of a subclassification of AML with myelodysplasia-related changes, although the degree of dysplasia in the myeloid and megakaryocytic lineages was <50 percent of the cells.

After performing genetic studies, there were no mutations identified on a 30-gene myeloid panel and cytogenetic testing showed 47, XY, +8, del20(q11.2q13.3) [20].

How would you characterize this patient’s disease?

  1. Favorable risk
  2. Intermediate risk
  3. Unfavorable risk

Let us know how you would respond at ashclinicalnews@hematology.org!

Disclaimer: ASH does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this article is solely at your own risk.

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