Acute Myeloblastic Leukemia: Difficulties of Treatment, Complications and Evolution

Tilinca Mariana¹, Benedek Lázár Erzsébet², Köpeczi Judith Beáta², Bacârea Anca³, Bănescu Claudia⁴, Benedek I², Bățagă Simona⁵

1 Department of Cellular and Molecular Biology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Hematology, Bone Marrow Transplantation Compartment, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Physiopathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Internal Medicine I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: This paper presents a special case of an acute myeloblastic leukemia accidentally diagnosed on a 57 years old asymptomatic person without occupational exposure, without a medical history, with normal blood count, without thrombocytopenia, as a result of routine hematological tests that reveal the presence of more than 10% blasts on peripheral blood smear.
Material and method: Bone marrow aspirate revealed 80% blasts and flow cytometry confirmed the diagnosis of acute myeloblastic leukemia LAM0. Cytogenetic examination showed normal karyotype 46, XX. The treatment aims to induce, maintain and consolidate remission. Since the classical therapeutical approach with Idarubicine and Cytarabine 3+7 was not tolerated, adjustments were necessary to 2+5, four courses being administered. During the remission period Methotrexate and Purinetol maintenance treatment was administered, it was obtained a tolerable quality of life, the patient resumed his work. The first relapse occurred after approximately one year. Later medical courses were established after chemotherapy protocol with Clofarabine and Cytarabine, but after intolerance, neutropenia, sepsis and death occured.
Results: Because of the severe prognosis and infectious complications the treatment was difficult and dose ajustments were necessary according to patient’s tolerance. Bone marrow transplant was not possible due to the lack of a compatible family donor.
Conclusions: This case of acute myelogenous leukemia treatment reflects the difficulties and complications occurred during the disease evolution. However remission periods with a tolerable quality of life were obtained, duration of treatment was approximately three years until death.