In the evolving field of hematology and oncology, addressing acute myeloid leukemia (AML) relapse after allogeneic hematopoietic stem cell transplantation (HSCT) is crucial. A recent study highlighting AML relapse as pericardial effusion marks significant progress in this area. Led by Professor Sizhou Feng from the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, this research underscores innovative diagnostic and therapeutic strategies.The primary aim is to understand the characteristics, diagnosis, treatment, and prognosis of isolated extramedullary relapse (IEMR) in AML patients post-allo-HSCT, with a specific focus on cardiac involvement.
A 35-year-old female with AML (normal chromosome karyotype, FAB class M5) was diagnosed with FLT3 exon20, ASXL1 exon12, Notch exon 25, and TET exon11 mutations. Initial treatment included induction chemotherapy and consolidation chemotherapy, achieving molecular complete remission (CR).
CT and pericardial effusion slides 15 months post-HSCT. (A) CT showed large pericardial effusion and eliminated the possibilities of pneumonia, large pleural effusion, or pneumothorax. (B) The first isolated pericardial relapse. Wright-Giemsa staining on pericardial effusion slides showed 95% immature monocytes. CT = computed tomography, HSCT = hematopoietic stem cell transplantation.
This case highlights the rarity and complexity of isolated cardiac extramedullary relapse in AML post-allo-HSCT. It underscores the necessity of thorough diagnostic evaluations for post-transplant patients with cardiac symptoms to differentiate between leukemic involvement, cardiotoxicity, GVHD, and infections.
Extramedullary relapse in AML post-allo-HSCT poses significant diagnostic and therapeutic challenges. Isolated cardiac involvement, as seen in this case, is particularly rare. Despite achieving hematologic CR with advanced therapies, the prognosis remains poor due to limited effective treatment options for EMR. This case underscores the need for more research to develop standardized treatment guidelines for EMR in AML patients post-allo-HSCT.
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