Chronic myelomonocytic leukemia with double-mutations in DNMT3A and FLT3-ITD treated with decitabine and sorafenib

Abstract

Chronic myelomonocytic leukemia (CMML) is a heterogeneous neoplastic hematologic disorder with worse overall survival. Half of CMML have mutations, but case with concomitant mutations of DNA methyltransferase 3A (DNMT3A) and Internal tandem duplications of the juxtamembrane domain of FLT3 (FLT3-ITD) in CMML was not reported before. We reported a 51-year-old man who had CMML with concomitant mutations in DNMT3A and FLT3-ITD.The patient received decitabine and sorafenib combined treatment. In this report, we reviewed DNMT3A mutation and FLT3 mutation, and we reviewed treatment of decitabine and sorafenib. This report is significant. First: This is the first report on CMML with double-mutations of DNMT3A and FLT3-ITD. Second: It shows the importance of targeted drug in combined treatment of CMML.

Keywords: CMML; DNMT3A; FLT3-ITD; double-mutations; sorafenib.

Figure 1.

Histopathology of bone marrow. (A) the Wright-Giemsa stain in bone marrow smear, the characteristic of monocytes (folded nuclei and delicate nuclear chromatin) is obvious. (B) a bone marrow biopsy specimen, the granulocytic component is most obvious in the biopsy specimen. (C,D) positive staining for CD15 and CD68 E, F: negativity for MPO and CD34.

Figure 2.

Phenotypic abnormalities of monocytes detected by a multicolor flow cytometric approach at initial diagnosis.

Figure 3.

Molecular genetics analysis of R882H DNMT3A mutation and FLT3-ITD mutation. (A) sequencing of R882H DNMT3A mutation. (B) PCR of FLT3-ITD mutation.

Figure 4.

Change trend of the peripheral monocytosis.