PMC4726703_01
Clinical course and various treatments received for our patient with FLT3+/trisomy 8 acute myeloid leukemia (AML). (a) The bone marrow blasts (%) are shown at different time points alongside the treatments received. (b) Schematic representation of selection pressure leading to development of a new clone of FLT3+/Trisomy 8 leukemia with the Philadelphia t(9;22) translocation. (c) The FLT3-ITD gene mutated to un-mutated peak height ratio is shown at different time points. Abbreviations: 7+3 - Induction chemotherapy with an anthracycline and cytarabine (see text for details/doses); SFN - Sorafenib; AZA - 5-Azacitadine; ASP2215 - Novel FLT3 inhibitor (NCT02014558); FluBu - Conditioning chemotherapy with fludarabine and busulfan; FluMel - Conditioning chemotherapy with Fludarabine and melphalan; MRD-SCT - Matched related stem cell transplant; MUD - SCT - Matched unrelated stem cell transplant; S-HAM - sequential high dose Ara-C chemotherapy with mitoxantrone.
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Bone marrow biopsy at day 28 demonstrated persistent disease with 10% bone marrow blasts (Fig. 1). The patient unfortunately had relapse of his leukemia on day +67 after his allo-HCT (Fig. 1). Patient, therefore, underwent conditioning chemotherapy with fludarabine and melphalan (FluMel) prior to a matched unrelated donor allogeneic transplant (MUD-SCT) (Fig. 1).