Skip to main content

Advertisement

SpringerLink
Log in

Azacytidine in Newly Diagnosed FLT3-ITD-Positive Acute Myeloid Leukemia Presenting with Pneumonia: A Case Series

  • Short Communication
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Acute myeloid leukemia (AML) is an aggressive disease that predisposes the patients to infections. FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) positive AML is a type of high-risk AML. Pneumonia is a common complication in patients of AML both due to the disease itself and as a result of induction chemotherapy. Treating AML patients who present with pneumonia is a challenge as induction chemotherapy further increases the severity and mortality of pneumonia as it causes myelosuppression. We report four patients with newly diagnosed FLT3-ITD-positive AML who had pneumonia at presentation. All four cases required induction chemotherapy with 7+3 which could not be given due to their poor general condition, secondary to pneumonia. Therefore, they were given low-intensity therapy, in the form of azacytidine, to prevent further progression of AML while they were recovering from pneumonia and became well enough to tolerate intensive induction chemotherapy. This treatment strategy of using a bridge before intensive chemotherapy was successful in our patients and 3 out 4 achieved documented remission. In our opinion, patients with newly diagnosed FLT3 positive AML with pneumonia can be given low-intensity chemotherapy such as azacytidine until the remission of pneumonia for better patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Cancer Stat Facts: Leukemia - Acute Myeloid Leukemia (AML). https://seer.cancer.gov/statfacts/html/amyl.html Accessed on 23 April 2019

  2. Burnett A, Wetzler M, Lowenberg B (2011) Therapeutic advances in acute myeloid leukemia. J Clin Oncol 29:487–494

    Article  Google Scholar 

  3. Cannas G, Pautas C, Raffoux E, Quesnel B, de Botton S, de Revel T et al (2012) Infectious complications in adult acute myeloid leukemia: analysis of the Acute Leukemia French Association-9802 prospective multicenter clinical trial. Leuk Lymphoma 53:1068–1076

    Article  CAS  Google Scholar 

  4. Garcia J, Lei X, Wierda W, Cortes J, Dickey B, Evans S et al (2013) Pneumonia incidence and risk factors in patients with acute leukemia. Ann Am Thorac Soc 10:432–440

    Article  Google Scholar 

  5. Rossini F, Verga M, Pioltelli P, Giltri G, Sancassani V, Pogliani EM et al (2000) Incidence and outcome of pneumonia in patients with acute leukemia receiving first induction therapy with anthracycline-containing regimens. Haematologica 85:1255–1260

    CAS  PubMed  Google Scholar 

  6. Buckley SA, Othus M, Vainstein V, Abkowitz JL, Estey EH, Walter RB (2014) Prediction of adverse events during intensive induction chemotherapy for acute myeloid leukemia or high-grade myelodysplastic syndromes. Am J Hematol 89:423–428

    Article  CAS  Google Scholar 

  7. Small D (2006) FLT3 mutations: biology and treatment. Hematol Am Soc Hematol Educ Program 178–184

  8. Tallman, Wang ES, Altman JK, Appelbaum FR, Bhatt VR, Bixby D et al (2019) Acute myeloid leukemia, version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 17(6):721–749

    Article  Google Scholar 

  9. Philip C, George B, Ganapule A, Korula A, Jain P, Alex AA et al (2015) Acute myeloid leukaemia: challenges and real world data from India. Br J Haematol 170:110–117

    Article  Google Scholar 

  10. Malfuson JV, Etienne A, Turlure P, de Revel T, Thomas X, Contentin N et al (2008) Risk factors and decision criteria for intensive chemotherapy in older patients with acute myeloid leukemia. Haematologica 93:1806–1813

    Article  CAS  Google Scholar 

  11. Walter RB, Estey EH (2015) Management of older or unfit patients with acute myeloid leukemia. Leukemia 29:770–775

    Article  CAS  Google Scholar 

  12. Dohner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Buchner T et al (2017) Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood 129:424–447

    Article  Google Scholar 

  13. Kaminskas E, Farrell AT, Wang YC, Sridhara R, Pazdur R (2005) FDA drug approval summary: azacitidine (5-azacytidine, Vidaza) for injectable suspension. Oncologist 10:176–182

    Article  CAS  Google Scholar 

  14. Christiansen DH, Andersen MK, Pedersen-Bjergaard J (2003) Methylation of p15INK4B is common, is associated with deletion of genes on chromosome arm 7q and predicts a poor prognosis in therapy-related myelodysplasia and acute myeloid leukemia. Leukemia 17:1813–1819

    Article  CAS  Google Scholar 

  15. Dombret H, Seymour JF, Butrym A, Wierzbowska A, Selleslag D, Jang JH et al (2015) International phase 3 study of azacitidine vs conventional care regimens in older patients with newly diagnosed AML with > 30% blasts. Blood 126:291–299

    Article  CAS  Google Scholar 

  16. Pleyer L, Dohner H, Dombret H, Seymour JF, Schuh AC, Beach CL et al (2017) Azacitidine for front-line therapy of patients with AML: reproducible efficacy established by direct comparison of international phase 3 trial data with registry data from the Austrian Azacitidine Registry of the AGMT Study Group. Int J Mol Sci. https://doi.org/10.3390/ijms18020415

    Article  PubMed  PubMed Central  Google Scholar 

  17. Laurillo L, Venditti A, Spagnoli A, Gaidano G, Ferrero D, Oliva E et al (2012) Azacitidine for the treatment of patients with acute myeloid leukemia: report of 82 patients enrolled in an Italian Compassionate Program. Cancer 118:1014–1022

    Article  Google Scholar 

  18. Stone RM, Mandrekar S, Sanford BL, Laumann K, Geyer S, Bloomfield CD et al (2017) Midostaurin plus chemotherapy for acute myeloid leukemia with a FLT3 mutation. N Engl J Med 377:454–464

    Article  CAS  Google Scholar 

  19. Levis M (2017) Midostaurin approved for FLT3-mutated AML. Blood 129:3403–3406

    Article  CAS  Google Scholar 

  20. Schiller GJ, Tuttle P, Desai P (2016) Allogeneic hematopoietic stem cell transplantation in FLT3-ITD-positive acute myelogenous leukemia: the role for FLT3 tyrosine kinase inhibitors post-transplantation. Biol Blood Marrow Transpl 22:982–990

    Article  CAS  Google Scholar 

  21. Wu M, Li C, Zhu X (2018) FLT3 inhibitors in acute myeloid leukemia. J Hematol Oncol 11:133

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hematology and BMT, Fortis Memorial Research Institute, Gurgaon, 122002, India

    Santosh Raut Kurmi, Aniruddha Dayama & Rahul Bhargava

Authors
  1. Santosh Raut Kurmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aniruddha Dayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rahul Bhargava
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aniruddha Dayama.

Ethics declarations

Conflict of interest

The authors report no potential conflicts of interest. In addition the patients gave informed written consent for all stages of treatment at regular intervals which was documented in patient record files and stored.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kurmi, S.R., Dayama, A. & Bhargava, R. Azacytidine in Newly Diagnosed FLT3-ITD-Positive Acute Myeloid Leukemia Presenting with Pneumonia: A Case Series. Indian J Hematol Blood Transfus 36, 377–380 (2020). https://doi.org/10.1007/s12288-019-01192-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-019-01192-9

Keywords

Search

Navigation