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Effectiveness of venetoclax and azacytidine against myeloid/natural killer cell precursor acute leukemia

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Abstract

Myeloid/natural killer (NK) cell precursor acute leukemia (MNKPL) is a rare leukemia subtype that possibly originates from precursor NK cells. The disease has a poor prognosis, and information on its treatment is lacking. We herein report the first case of a 46-year-old woman with MNKPL who was refractory to two lines of acute myeloid leukemia (AML)-type intensive chemotherapy but was successfully treated with venetoclax and azacytidine (VEN/AZA). She was diagnosed with MNKPL based on the conformations of immature lymphoblastoid morphology without myeloperoxidase reactivity that showed a CD7/CD33/CD34/CD56/HLA-DR positive phenotype and extramedullary regions. The disease was refractory to induction therapy with daunorubicin and cytarabine (DNR/Ara-C) and to reinduction therapy with mitoxantrone, etoposide, and cytarabine (MEC). After two lines of induction chemotherapy, massive pericardial and pleural effusion was found, and was suspected to be extramedullary lesions. The patient developed cardiac tamponade and required pericardiocentesis. Thus, VEN/AZA was administered as third-line therapy. After two cycles of VEN/AZA, the pericardial and pleural effusion disappeared, and complete remission was achieved. The patient received post-transplant cyclophosphamide-based haploidentical transplantation and has stayed relapse-free as of her last follow-up examination 2 years after diagnosis.

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Authors and Affiliations

  1. Department of Hematology, Osaka Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita-Ku, Osaka, 530-0012, Japan

    Ichiro Shiomi, Takahiko Nakane, Yumi Ogawa, Taku Araki, Yotaro Fujitani & Ryosuke Yamamura

  2. Department of Hematology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan

    Soichiro Nakako, Masayuki Hino & Hirohisa Nakamae

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  1. Ichiro Shiomi
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  2. Soichiro Nakako
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  3. Takahiko Nakane
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  4. Yumi Ogawa
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  5. Taku Araki
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  6. Yotaro Fujitani
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  7. Ryosuke Yamamura
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  8. Masayuki Hino
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  9. Hirohisa Nakamae
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Correspondence to Takahiko Nakane.

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Shiomi, I., Nakako, S., Nakane, T. et al. Effectiveness of venetoclax and azacytidine against myeloid/natural killer cell precursor acute leukemia. Int J Hematol 119, 88–92 (2024). https://doi.org/10.1007/s12185-023-03678-9

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  • DOI: https://doi.org/10.1007/s12185-023-03678-9

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