FLT-3 ITD Positive Acute Basophilic Leukemia with Rare Complex Karyotype Presenting with Acute Respiratory Failure: Case Report

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Abstract

Background: Acute basophilic leukemia is a rare subtype of acute myeloid leukemia, as categorized by the 2008 World Health Organization classification of myeloid neoplasms. Acute basophilic leukemia diagnosis requires thorough morphological, cytochemical, immunophenotypic, molecular, and cytogenetic studies and exclusion of other hematological neoplasms associating basophilia. The disease course is defined by histamine driven, occasionally life-threatening respiratory, cardiovascular, cutaneous or digestive complications, as well as primary refractoriness to standard therapy. Clinical presentation: We herein report a case of a 63-year-old asthmatic female patient diagnosed with acute basophilic leukemia, associated with previously unpublished cytogenetic features and FLT-3 ITD mutation, pulmonary leukostasis and spontaneous pulmonary capillary leak syndrome, which worsened immediately following chemotherapy initiation. Respiratory complications were successfully managed, but recrudesced upon emergence of refractory disease and were ultimately fatal. We highlight the likelihood of pulmonary complications induced by basophil degranulation and tumor lysis in hypercellular acute basophilic leukemia and the potential benefit of histamine receptor blockade in this setting.

1. Arber DA, Brunning RD, Orazi A, Porwit A, Peterson L, Thiele J, et al. Acute Basophilic Leukemia. In: Swerdlow SH, Campo E, Harris NL, et al., editors. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon (Fr): IARC Press; 2008. p 137-8.

2. Luo X-H, Zhu Y, Tang X-Q. Acute basophilic leukemia presenting with maculopapular rashes and a gastric ulcer: A case report. Oncol Lett. 2014;8(6):2513-6. DOI: 10.3892/ol.2014.2544

3. Bernini JC, Timmons CF, Sandler ES. Acute basophilic leukemia in a child. Anaphylactoid reaction and coagulopathy secondary to vincristine-mediated degranulation. Cancer. 1995;75:110-4. DOI: 10.1002/1097-0142(19950101)75:1<110::AID-CNCR2820750118>3.0.CO;2-I

4. Kritharis A, Brody J, Koduru P, Teichberg S, Allen SL. Acute basophilic leukemia associated with loss of gene ETV6 and protean complications. J Clin Oncol. 2011;29(21):623-6. DOI: 10.1200/JCO.2010.34.5710

5. Pidala J, Pinilla-Ibarz J, Cualing HD. A case of acute basophilic leukemia arising from chronic myelogenous leukemia with development of t(7;8)(q32;q13). Cancer Genet Cytogenet. 2008;182(1):46-9. DOI: 10.1016/j.cancergencyto.2007.12.009

6. Eveillard M, Desjonqueres A, de Nantes C. Acute basophilic leukemia. Blood. 2014;123(20):3071. DOI: 10.1182/blood-2014-02-555698

7. Shvidel L, Shaft D, Stark B, Shtalrid M, Berrebi A, Resnitzky P. Acute basophilic leukaemia: Eight unsuspected new cases diagnosed by electron microscopy. Br J Haematol. 2003;120(5):774-81. DOI: 10.1046/j.1365-2141.2003.04167.x

8. Zhao Y, Kong D, Han L, Hu LH, Zhang Z, Liu JJ, et al. Arsenic trioxide in treatment of de novo acute basophilic leukemia. Chin Med J. 2013;126(3):593-4.

9. Dastugue N, Duchayne E, Kuhlein E, Rubie H, Demur C, Aurich J, et al. Acute basophilic leukaemia and translocation t(X;6)(p11;q23). Br J Haematol. 1997;98(1):170-6. DOI: 10.1046/j.1365-2141.1997.1562968.x

10. Seth T, Vora A, Bhutani M, Ganessan K, Jain P, Kochupillai V. Acute basophilic leukemia with t(8;21). Leuk Lymphoma. 2004;45(3):605-8. DOI: 10.1080/10428190310001598053

11. Kokandakar H, Tembhare P, Mamoon A, Mulay VM, Bhople KS. Acute basophilic leukaemia: A case report.Indian J Pathol Microbiol. 2007;50(2):443-6.

12. Bahmanyar M, Chang H. Acute myeloid leukemia with myelodysplasia-related changes demonstrating prominent basophilic differentiation. Blood. 2016;127(20):2503. DOI: 10.1182/ blood-2016-02-701144

13. Giagounidis A, Hildebrandt B, Heinsch M, Germing U, Aivado M, Aul C. Acute basophilic leukemia. Eur J Haematol. 2001;67(2):72-6. DOI: 10.1034/j.1600-0609.2001.t01-1-00487.x

14. Valent P, Sotlar K, Blatt K, Hartmann K, Reiter A, Sadovnik I, et al. Proposed diagnostic criteria and classification of basophilic leukemias and related disorders. Leukemia. 2017;31(4):788-97. DOI: 10.1038/leu.2017.15

15. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood.2016;127(20):2391-405. DOI: 10.1182/blood-2016-03-643544

16. Staal-Viliare A, Latger-Cannard V, Rault J, Didion J, Grégoire MJ, Bologna S, et al. À propos d’un cas de leucémie à basophiles de novo: Critères diagnostiques et revue de la littérature. Ann Biol Clin. 2006;64(4):361-5.

17. Kottaridis PD, Gale RE, Frew ME, Harrison G, Langabeer SE, Belton AA, et al. The presence of a FLT3 internal tandem duplication in patients with acute myeloid leukemia (AML) adds important prognostic information to cytogenetic risk group and response to the first cycle of chemotherapy: Analysis of 854 patients from the United Kingdom medical research council AML 10 and 12 trials. Blood. 2001;98(6):1752-9. DOI: 10.1182/ blood.V98.6.1752

18. Schnittger S, Schoch C, Dugas M, Kern W, Staib P, Wuchter C, et al. Analysis of FLT3 length mutations in 1003 patients with acute myeloid leukemia: Correlation to cytogenetics, FAB subtype, and prognosis in the AMLCG study and usefulness as a marker for the detection of minimal residual disease. Blood. 2002;100(1):59-66. DOI: 10.1182/blood.V100.1.59

19. Shvidel L, Sigler E, Shtalrid M, Berrebi A, Resnitzky P. Hybrid eosinophilic-basophilic acute myeloid leukaemia diagnosed by electron microscopy. Br J Haematol. 2007;137(4):381-3. DOI: 10.1111/j.1365-2141.2007.06579.x

20. Gauvreau GM, Ellis AK, Denburg JA. Haemopoietic processes in allergic disease: Eosinophil/basophil development. Clin Exp Allergy. 2009;39(9):1297-306. DOI: 10.1111/j.1365-2222.2009.03325.x

21. Porcu P, Cripe LD, Nq EW, Bhatia S, Danielson CM, Orazi A, et al. Hyperleukocytic Leukemias and Leukostasis: A review of pathophysiology, clinical presentationand management. Leuk Lymphoma. 2000;39(1- 2):1-18. DOI: 10.3109/10428190009053534

22. Novotny JR, Nuckel H, Duhrsen U. Correlation between expression of CD56/NCAM and severe leukostasis in hyperleukocytic acute myelomonocytic leukaemia. Eur J Haematol. 2006;76(4):299-308. DOI: 10.1111/j.1600-0609.2005.00607.x

23. Azoulay É, Fieux F, Moreau D, Thiery G, Rousselot P, Parrot A, et al. Acute Monocytic leukemia presenting as acute respiratory failure. Am J Respir Crit Care Med. 2003;167(10):1329-33. DOI: 10.1164/rccm. 200206-554OC

24. Myers TJ, Cole SR, Klatsky AU, Hild DH. Respiratory failure due to pulmonary leukostasis following chemotherapy of acute nonlymphocytic leukemia. Cancer. 1983;51(10):1808-13. DOI: 10.1002/1097-0142(19830515)51:10<1808::AID-CNCR2820511009> 3.0.CO;2-Y

25. Dombret H, Hunault M, Faucher C, Dombret MC, Degos L. Acute lysis pneumopathy after chemotherapy for acute myelomonocytic leukemia with abnormal marrow eosinophils. Cancer. 1992;69:1356-61. DOI: 10.1002/1097-0142(19920315)69:6<1356::AID-CNCR2820690609>3.0.CO;2-B

26. Lester WA, Hull DR, Fegan CD, Morris TC. Respiratory failure during induction chemotherapy for acute myelomonocytic leukaemia (FAB M4Eo) with Ara-C and all-trans retinoic acid. Br J Haematol. 2000;109(4):847-50. DOI: 10.1046/j.1365-2141.2000.02043.x

27. Frederiksen JK, Shao L, Bixby DL, Ross CW. Shared clonal cytogenetic abnormalities in aberrant mast cells and leukemic myeloid blasts detected by single nucleotide polymorphism microarray-based whole-genome scanning. Gene Chromosome Canc. 2016;55(4):389-96.DOI: 10.1002/gcc.22342

28. Arock M, Schneider E, Boissan M, Tricottet V, Dy M. Differentiation of human basophils: An overview of recent advances and pending questions. J Leukoc Biol. 2002;71(4):557-64.

Revista Romana de Medicina de Laborator

Romanian Journal of Laboratory Medicine

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