Hematopoietic cell transplantation for myeloid/NK cell precursor acute leukemia in second remission

Abstract

Myeloid/natural killer cell precursor acute leukemia (MNKPL) is a rare leukemia subtype characterized by a high incidence of extramedullary infiltration. No appropriate treatment strategy has so far been developed. Acute myelogenous leukemia-type chemotherapy combined with L-Asparaginase is an effective treatment for MNKPL. Hematopoietic cell transplantation is a second option in refractory cases.

Keywords: Hematopoietic cell transplantation; L‐Asparaginase; myeloid/natural killer cell precursor acute leukemia.

Figure 1

(A) ¹⁸F‐FDG PET/CT shows hypermetabolic lesions in multiple lymphoid organs, especially the bilateral cervical and axillar lymph nodes. FDG, fluorodeoxyglucose; PET/CT, positron emission tomography/computed tomography. (B) Wright–Giemsa staining of a bone marrow aspiration smear. Blast cells are relatively large and harbor fine azurophilic granules in the cytoplasm.

Figure 2

(A) Photomicrograph of a lymph node specimen. H‐E = hematoxylin–eosin staining. Low = lower magnification, High = higher magnification. (B) Dot blot graph of flow cytometric data. The CD45 dull population was analyzed using the indicated antibody. NC = normal control IgG.

Figure 3

Clinical course of the patient. CM: cytarabine, 200 mg/m² × 7 days + mitoxantrone, 5 mg/m² × 5 days; HCEI: cytarabine, 3 g/m² q12 h × 3 days + etoposide, 100 mg/m² × 5 days + idarubicin, 10 mg/m²; HCM: cytarabine, 2 g/m² q12 h × 3 days + mitoxantrone, 5 mg/m² × 5 days; L‐asparaginase: 10,000 U/m²; TIT: methotrexate, 12 mg + cytarabine, 30 mg + hydrocortisone, 25 mg; IDA‐FLAG: IDA, 10 mg/m² × 3 days + fludarabine, 30 mg/m² × 5 days + cytarabine, 2 g/m² q12 h × 3 days + G‐CSF, 5 μg/kg × 6 days; Capizzi: cytarabine 3 g/m² q12 h × 3 days + L‐Asp, 10,000 U/m² × 5 days; LDEC: AraC, 20 mg/m² × 1 day + etoposide, 30 mg/m² × 1 day.