New perspectives on treatment strategies for patient with acute myeloid leukemia and complex karyotype abnormalities after percutaneous coronary intervention

Figures

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  Figure 1. Initial coronary angiogram showed that left anterior descending coronary artery (LAD) and left circumflex branch (LCX) has mild stenosis. In November 2011, initial coronary angiography examination showed that both the left anterior descending coronary artery (LAD) and left circumflex branch (LCX) had 30% to 40% stenosis in the middle portion.

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  Figure 2. A year later, the coronary angiography examination showed stenosis degree aggravating than earlier. In November 2012, because of chest pain and the other symptoms significantly worse than before, so the patient underwent coronary angiography examination again, the results showed that the 75% localized stenosis was seen in the middle proption of the LAD, and 60% localized stenosis was seen in the middle proption of the LCX.

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  Figure 3. The final coronary angiogram showed a successfully implanted stent at the LAD. The pathological changes were quickly resolved by percutaneous transluminal coronary angioplasty and placement of 1 drug-eluting stents in the LAD.

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  Figure 4. The results of bone marrow examination when the patient had unknown pancytopenia and suspected with hematological diseases. Bone marrow aspiration revealed abundant, immature myeloid cells with coalescent granules, and histochemical staining showed peroxidase staining positive rate approximate 83% and alkaline phosphatase staining rate approximate 2%.

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  Figure 5. The results of chromosome karyotype analysis and immunophenotype. Conventional cytogenetic analysis was carried out on direct preparations, and immunophenotype was performed on isolated bone marrow mononuclear cells by flow cytometry after collection according to standard procedure. Cytogenetic karyotypes revealed 88∼9,XX,YY,2 × t(8;21)(q22;q22)[20], and immunophenotype suggested myeloid expression with HLA-DR, CD13, CD15, CD19, CD33, CD34, CD38, CD56, CD64, CD117, CD123, MPO.

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  Figure 6. The results of bone marrow and peripheral examination after chemotherapy. Bone marrow morphology that revealed no clusters or collections of blast cells, and peripheral blood smear could not observe bone marrow blast cell.

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  Figure 7. The results of cytogenetic karyotypes and minimal residual disease (MRD) during the patient followed up in clinic. Cytogenetic karyotypes and MRD was detected during the patient followed up in clinic, and the sesults showed continuous complete remission after chemotherapy.