Case report: High-risk acute promyelocytic leukemia and COVID-19-related myocarditis one patient, two cytokine storms.

Acute promyelocytic leukemia (APL) is a unique, highly curable subtype of acute myeloid leukemia, owing to the therapeutic advances of the last decades which led to high complete remission rates and excellent long-term survival. Nevertheless, it remains associated with high early mortality rates. Early death is the major cause of treatment failure in APL and is mainly attributed to coagulopathy, differentiation syndrome, and less commonly, infectious events. Timely recognition of each complication plays a crucial role in the management of patients diagnosed with APL. Coronavirus Infectious Disease 2019 (COVID-19) has shown great heterogeneity in patient presentation. Clinical manifestations range from asymptomatic disease to severe forms, mainly characterized by a hyperinflammatory syndrome leading to acute respiratory distress and multiorgan failure. Patients with acute leukemia and concomitant COVID-19-related hyperinflammatory syndrome have particularly poor outcomes. We hereby report the case of a 28-year-old male patient who was diagnosed with high-risk APL, with severe associated coagulopathy at presentation. He was treated with chemotherapy according to the AIDA regimen. The first week of induction therapy was complicated by a differentiation syndrome manifesting as fever not attributable to infection and respiratory distress with pulmonary infiltrates, resolved after ATRA discontinuation and corticotherapy. On the fourth week of treatment, he tested positive for acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with minor pulmonary involvement. Clinical manifestations over the following days included tachycardia and hypotension, associated with elevated inflammatory markers and cardiac biomarkers (troponin I x58 upper NV). Cardiovascular magnetic resonance imaging was consistent with myocarditis. COVID-19-associated myocarditis was successfully treated with methylprednisolone, intravenous immunoglobulins and Anakinra. Differentiation syndrome and COVID-19-associated myocarditis are two life-threatening complications that adversely impact survival. However, early recognition and prompt treatment initiation can improve clinical outcomes, as was the case of our patient.

Refractory anemia with ringed sideroblasts and thrombocytosis without JAK2 V617F mutation: report of three cases.

In the WHO classification, there is a provisional entity called Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable (MDS/MPN, U). Refractory anemia with ringed sideroblasts associated with marked thrombocytosis (RARS-T) was included in this category. Recently published studies report a small percentage of patients with RARS-T. Sixty percent of these have JAK2 V617F mutation, which can suggest the coexistence of two pathological conditions (MDS and MPN). In this paper, we analyzed three patients diagnosed with RARS-T in the Department of Hematology, "Fundeni" Clinical Institute, Bucharest, Romania, during the period 2005-2011. The patients were investigated with cytogenetic exam and molecular biology. In these three cases were identified morphological features of multilineage dysplasia (two-lineage dysplasia in two cases and three-lineage dysplasia in one case). In two cases, thrombocytosis was under 1000×10(3)/µL and clinical evolution was similar to the myelodysplastic syndrome (transfusion dependent anemia with response to administration of erythropoietin). In the third case, the platelets were over 1000×10(3)/µL and with response to the treatment with Hydrea, which improved anemia. JAK2 V617F mutation was not identified in any case. RARS-T remains a provisional entity and requires a complex investigation of patients for the correct diagnosis of these patients. Therapeutic options should be personalized to each case in part because there is not yet a standardized treatment of these patients.

Epidemiological data from the registry of patients with myelodysplastic syndrome in a single hospital center of Romania.

We present the first Romanian study on the epidemiological characteristics of MDS, based on the data existing in Fundeni Clinical Institute, Hematological Department, Bucharest. The files at diagnosis of the adult patients with primary MDS admitted during the period 1982-2005, recorded in the registration forms provided by the MDS Foundation (USA), represented the primary database. This study indicates an increase in the number of new MDS cases over the period of time investigated. Also, a 10 years lower median age of the patients, a noticeable proportion of young patients and a low proportion of patients >or=81 years have been found, which situates our findings in the middle between the Eastern and Western epidemiological reported data on MDS.

Hypolipemiant besides antileukemic effect of imatinib mesylate.

The use of imatinib mesylate (IM) (Gleevec, Novartis) in chronic myeloid leukemia (CML) and other neoplastic disorders is in a dramatic increase, inducing long-standing survival. Therefore, the interest in the associated events with this treatment is more and more manifest. We describe a case of CML in which, at the usual antileukemic dose, IM induced a rapid and persistent normalization of the levels of serum cholesterol, triglycerides, low- and high-density lipoproteins and glucose. In the present case report we confirm other observations on the hypolipemiant and antidiabetic effects, concomitant with that antileukemic, of IM.

Laparoscopic splenectomy can induce significant improvement in hypoplastic myelodysplastic syndrome.

A 20 years old male patient was diagnosed as hypoplastic myelodysplastic syndrome (hMDS) - refractory cytopenia with multilineage dysplasia in November 2002. He received packed blood cells, methylprednisolon and dexamethason but no persistent improvement and even worsening of the thrombocytopenia and the appearance of neutropenia were registered. Laparoscopic splenectomy has been performed in January 2003, when the platelets were approximately 15000/mm3, without intraoperative incidents. After splenectomy, no other therapy or transfusions have been applied and a slow but continuous improvement of the peripheral blood counts up to normal values has been noted. In the bone marrow, a notable increase of cellular density was registered after more than three years from splenectomy, with the persistence of the other morphological dysplastic features.