title: Acute myeloid leukemia in first remission: to choose transplantation or not?
abstract: A 42-year-old woman presented with bruising and fatigue. Her WBC count was 10,370/μL, with a differential showing 5% polys, 5% monos, 10% lymphocytes, and 80% myeloid-appearing blasts, some of which contained Auer rods (Fig 1). Bone marrow examination revealed 90% infiltration with myeloid-appearing blasts, and flow cytometry analysis confirmed the diagnosis of acute myeloid leukemia (AML) with expression of CD33, CD13, and CD117. Cytogenetics revealed a normal female karyotype; molecular testing for NPM1, FLT3-ITD, and CEBPαmutations revealed wild-type status for each gene. The patient received induction therapy with daunorubicin 90 mg/m(2) per day for 3 days and continuous-infusion cytarabine 100 mg/m(2) per day for 7 days. After an induction course complicated by Gram-negative bacterial sepsis, her counts recovered by day 32, and bone marrow examination 6 weeks after diagnosis showed a complete remission. One week later she feels well and has normal physical and laboratory examinations. She is an only child (but has a common HLA type) and presents for discussion of postremission therapy options.
authors: Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA. richard_stone@dfci.harvard.edu
authors: Richard M
authors: RM
authors: Stone
mesh_terms: D000208:Acute Disease; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D003657:Decision Making; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D000090243:Nucleophosmin; D057240:Patient Preference / Q000523:psychology; D012074:Remission Induction; D012196:Review Literature as Topic; D033581:Stem Cell Transplantation / Q000379:methods / Q000523:psychology; D014184:Transplantation, Homologous
chemical_list: C000716967:NPM1 protein, human; D003561:Cytarabine; D000090243:Nucleophosmin; D003630:Daunorubicin