Acute promyelocytic leukemia with additional chromosome abnormalities in a patient positive for HIV: A case report and literature review

Abstract

Acute promyelocytic leukemia (APL), especially cases of high-risk with complex chromosomes (CK), is rare in individuals infected with human immunodeficiency virus (HIV), making the establishment of therapeutic approaches challenging; often the treatment is individualized. This report describes a 49-year-old female patient with HIV who was diagnosed with high-risk APL with a new CK translocation and presents a literature review. At diagnosis, the patient presented with typical t(15;17)(q24;q21) with additional abnormalities, including add(5)(q15), add(5)(q31), add(7)(q11.2) and add(12) (p13). The results of acute myeloid leukemia mutation analysis suggested positivity for calreticulin and lysine methyltransferase 2C genes. The patient received all-trans retinoic acid combined with arsenic trioxide and chemotherapy, with morphologically complete remission after the first cycle of chemotherapy. The present report provided preliminary data for future clinical research.

Keywords: acute promyelocytic leukemia; complex chromosomes; human immunodeficiency virus.

Figure 1.

Bone marrow shows obvious premyelocytes at the time of the acute promyelocytic leukemia diagnosis. Magnification, (A) ×10 and (B) ×100. Bone marrow at the time complete remission) showed the proportion of particle lines decreased significantly, and the proportion of erythroid lines increased significantly. Magnification, (C) ×10 and (D) ×100.

Figure 2.

Karyotype from bone marrow specimen at the time of diagnosis of acute promyelocytic leukemia showing 46,XX, add(5)(q15), add(5)(q31), add(7)(q11.2), add(12)(p13), t(15;17)(q24; q21)[19]/46, XX. Arrows show the translocation t(15;17).

Figure 3.

Brain computed tomography images. Arrows point to an intracerebral hemorrhage).

Figure 4.

Karyotyping of bone marrow specimen at time of the acute promyelocytic leukemia-complete remission, showing 46,XX (2022/8).

Figure 5.

Patient platelet transfusion during the hospitalization. (A) Patient platelet transfusion during the first hospitalization. (B) Platelet transfusion unit during the first hospitalization (Days post-admission). (C) Patient platelet transfusion during the second hospitalization. (D) Platelet transfusion unit during the second hospitalization (Days post-admission).

Figure 6.

Patient hemoglobin transfusion during the hospitalization. (A) Patient hemoglobin transfusion during the first hospitalization. (B) Hemoglobin transfusion unit during the first hospitalization (Days post-admission). (C) Patient hemoglobin transfusion during the second hospitalization. (D) Hemoglobin transfusion unit during the second hospitalization (Days post-admission).