case_images: PMC10350419_01
case_images: Bone marrow smear at onset of AML, first relapse of AML, 24 months after gilteritinib therapy, and relapse after gilteritinib cessation. (A and B) Wright-Giemsa (WG) staining at onset, showing extensive bone marrow necrosis. (C) Myeloperoxidase (MPO) staining at onset. (D-F) WG staining at first relapse, showing myeloblast increase without blood cell dysplasia. (G-I) WG staining at 24 months after gilteritinib therapy, showing multi-lineage blood cell dysplasia without myeloblast increase. (J-L) WG staining at relapse after gilteritinib cessation (35 months after gilteritinib treatment), showing a repopulation of myeloblasts against the background of multilineage dysplasia. Magnification is 100x for (A, D, G, and J), and 1000x for (B, C, E, F, H, I, K, and L).
case_images: OTT-16-571-g0001.jpg
case_images: PMC10350419_01_OTT-16-571-g0001.jpg
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case_images: Bone marrow (BM) examination revealed myeloperoxidase-positive leukemic cells and extensive BM necrosis (Figure 1A-C). She subsequently underwent two courses of azacytidine, followed by three courses of cytarabine, aclarubicin, and granulocyte-colony stimulating factor; however, AML relapsed eight months after the first HCR (Figure 1D-F). Each BM examination revealed the continuation of multi-lineage blood cell dysplasia without an increase in myeloblasts (Figure 1G-I). BM examination revealed 10% myeloblasts (Figure 1J-L), and FLT3-ITD was again detected by qualitative polymerase chain reaction (PCR).