Genetic diagnostics and treatment of young adult acute myelomonoblastic leukemia patient using double haploidentic bone marrow transplantation



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Abstract

Treatment ofprognostically unfavorable forms ofacute leukemia isaserious problem ofhematology, since their frequency inthe group ofadult patients reaches 60%, and inelderly patients- 80-90%.Aim: toanalyze the case ofdiagnostics and treatment ofacute myelomonoblastic leukemia with anunfavorable genetic prognosis inayoung adult female using double haploidentical bone marrow transplantation.Samples ofbone marrow and peripheral blood ofpatient K., 35years old, who recived program chemotherapy and double haploidentical bone marrow transplantation inthe Sverdlovsk Regional Hematological Centre were examined.Atthe onset ofdisease was noted hyperleukocytosis, blastaemia and infiltration ofleukemic cells inthe bone marrow. Cytochemical reactions tolipids were positive in7,0% ofblasts, small-granular and large-granular glycogen was detected in24,0% ofblast cells, and diffuse- in22,0%. Immunophenotypically, 28,0% ofblast cells were characterized byexpression ofHLA-DR, CD13, CD33, CD34, CD38, CD117, MPO-cyt, 13,0%- CD33, CD11cyt, CD64, CD14. The cytogenetic study determined the karyotype 48, XX, +4, +21[2]/ 47, XX, +4[3]/ 46, XX[2]. Non-synonymous transversions с. 2447A>Тinс-KIT gene, с.215С>GinТР53, and transition с. 2644С>ТinDNMT3A were detected using direct sequencing method. Despite the detection ofoncogenic mutations, the tumor was chemosensitive topolychemotherapy (including anthracyclines with cytarabine). However, given the unfavorable genetic prognosis, itwas decided toperform abone marrow transplantation. Due tothe lack ofanHLA-matched unrelated donor, the first haploidentical transplantation was performed from the patient'seldest daughter. At+51day, transfusion ofdonor white blood cells with correction ofthe immunosuppression scheme was performed tocorrect persistent pancytopenia. At+ 71day after the first transplantation, taking into account the remaining pancytopenia, asecond haploidentic transplantation from the patient'syounger daughter was performed. The total duration ofhematological remission was 48months, including 36months after the second haploidentical bone marrow transplantation.

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About the authors

A. V Vinogradov

Ural State Medical University; Sverdlovsk Regional Clinical Hospital N 1

Email: a.vinogradov@egov66.ru

D. V Izotov

Ural State Medical University

A. V Rezaykin

Ural State Medical University

I. V Anisimova

Sverdlovsk Regional Clinical Hospital N 1

T. S Konstantinova

Ural State Medical University; Sverdlovsk Regional Clinical Hospital N 1

A. V Kudryashova

Sverdlovsk Regional Clinical Hospital N 1

S. V Sazonov

Ural State Medical University; Institute of Medical Cell Technologies

A. G Sergeev

Ural State Medical University

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