PMC10350419_01
Bone marrow smear at onset of AML, first relapse of AML, 24 months after gilteritinib therapy, and relapse after gilteritinib cessation. (A and B) Wright-Giemsa (WG) staining at onset, showing extensive bone marrow necrosis. (C) Myeloperoxidase (MPO) staining at onset. (D-F) WG staining at first relapse, showing myeloblast increase without blood cell dysplasia. (G-I) WG staining at 24 months after gilteritinib therapy, showing multi-lineage blood cell dysplasia without myeloblast increase. (J-L) WG staining at relapse after gilteritinib cessation (35 months after gilteritinib treatment), showing a repopulation of myeloblasts against the background of multilineage dysplasia. Magnification is 100x for (A, D, G, and J), and 1000x for (B, C, E, F, H, I, K, and L).
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Bone marrow (BM) examination revealed myeloperoxidase-positive leukemic cells and extensive BM necrosis (Figure 1A-C). She subsequently underwent two courses of azacytidine, followed by three courses of cytarabine, aclarubicin, and granulocyte-colony stimulating factor; however, AML relapsed eight months after the first HCR (Figure 1D-F). Each BM examination revealed the continuation of multi-lineage blood cell dysplasia without an increase in myeloblasts (Figure 1G-I). BM examination revealed 10% myeloblasts (Figure 1J-L), and FLT3-ITD was again detected by qualitative polymerase chain reaction (PCR).