A recurrent acute myeloid leukemia with pericardial effusion after allogeneic hematopoietic stem cell transplantation

Abstract

 This case describes a 38-year-old woman who visited her previous physician because of fever and general malaise that she had experienced since March 2014. An increased leukocyte count was observed, and the patient was subsequently referred to our department. She was diagnosed with acute myeloid leukemia (AML) and achieved complete remission with remission induction therapy given in accordance with the JALSG AML201 protocol. However, AML relapsed after remission therapy. FLAGM therapy was performed for the re-induction of remission but was ineffective. The patient was consequently pre-treated with gemtuzumab ozogamicin, and subsequently underwent peripheral blood stem cell transplantation from a related donor in October. Although a bone marrow aspiration performed on day 33 revealed that complete remission had been achieved, peripheral hemoblasts were detected on day 47. Immediately after transplantation the patient presented with heart failure which was resistant to drug treatment, indicating a refractory condition. Moreover, AML invasion was confirmed through pericardiocentesis. The patient did not wish to undergo aggressive therapy and eventually died in December. Here, we report a rare case of pericardial invasion that occurred after hematopoietic stem cell transplantation.