Abstracts Clinical Lymphoma, Myeloma & Leukemia September 2023 S274 AML-159 Case Report: Successful Management of Unusual Toxicity of Arsenic Trioxide (ATO) on Day 10 of Consolidation in Acute Promyelocytic Leukemia (APL) Nour A.Haidar MD, Lionel Ades MD/PHD, Marie Sebert MD, Pierre Fenaux MD/PHD Saint Louis Hospital, Paris, France APL is the rarest form of acute myelogenous leukemia. Advances in the treatment of APL have transformed this disease from a condition associated with significant morbidity and mortality to one with an excellent outcome. We present a case of a 68-year-old male who presented with delirium at the Saint Louis Hospital in July 2016. He was diagnosed with AML and achieved complete remission on day 10 of the first consolidation by ATRA/ATO. A neurologic examination revealed fluctuating delirium with temporospatial disorientation. During exploration, he was unable to focus. Cranial nerves were fully intact, and muscle strength was 5/5 throughout. He was hyper-reflexive on the right side compared with the left, and his toes were curled bilaterally, with no tremors or dysmetria. After a few hours, the patient experienced a sudden neurological deterioration with coma Glasgow 3. He was transferred to the intensive care unit. Consolidation therapy was discontinued due to neurological degradation. A Total CT scan was normal, and MRI showed no T2 signal changes. A lumbar puncture showed a WBC count 1, glucose 4.46 mmol/l, and protein 0.54. CSF cultures were negative, and a normal EEG. Investigations revealed a WBC of 6.64/mm3, hemoglobin 8.6 g/l, blasts 0%, normal electrolytes, bacteriology, and virology were negatives. The level of arsenic in the urine was 11394 ug/L (N 0 - 50 ug/L). The results of CNS investigations were normal. Thus, the focus of the differential diagnosis shifted towards a primary psychiatric disorder. Based on consultation with the psychiatrist, there was no basis for a psychiatric decompression of thymic origin. The patient was diagnosed with an iatrogenic confusional syndrome caused by arsenic toxicity. The patient was treated with succimer 600 mg TID for 10 days with monitoring of the level of arsenic in the urine. On day 4 of treatment with succimer, the patient had a slow favorable resolution of symptoms with a clear improvement of temporal-spatial disorientation and nocturnal agitation. Arsenic trioxide is not known to cause encephalopathic side effects in leukemia patients. However, the side effect observed in this patient were reversible. The patient was treated with idarubicin + ATRA per guidelines and achieved complete remission. Keywords: APL, acute promyelocytic leukemia, arsenic trioxide, ATO, retinoic acid, encephalopathy AML-160 Unusual Side Effect of Arsenic Trioxide (ATO) in Acute Promyelocytic Leukemia (APL): A Case Report Nour A.Haidar MD, Lionel Ades MD, PhD, Marie Sebert MD, Pierre Fenaux MD, PhD Saint Louis Hospital, Paris, France APL is a rare subtype of acute myeloid leukemia (AML), characterized by the t(15;17) translocation. Patients have a favorable prognosis upon immediate recognition and treatment. With the introduction of all-trans-retinoic acid (ATRA) and the recent development of therapies including arsenic trioxide (ATO), APL is considered the most curable form of AML. We present a case of 79-year-old male, who presented to the emergency room in July 2022 with severe fatigue, dyspnea, high grade fever. His blood test showed Hb of 10 g/dl, thrombocytopenia and leukopenia (WBC 0.5×10⁹/l) and neutrophil count of 0.2 G/L. The patient was admitted to the hospital with an initial diagnosis of pneumonia based on the results of a thoracic scan. After 2 days, an ecchymosis purpura extending to the upper limbs was observed with a hematoma of the left elbow. Blood test showed and Hb of 10.3 G/dl, WBC 16.8 G/L, and PLT 19 G/L. The patient received a transfusion of PFC and platelets. The patient had bicytopenia and hyperleukocytosis (Hb 7.5 G/dl, WBC 27.7 G/L, and PLT 25 G/ L). A bone marrow biopsy and flow cytometry showed a PML-RARA transcripts and a t(15;17). The patient was negative for acute leukemia. Hypercellular aspirate showed 94% blasts. The patient was diagnosed with APL and was transferred to the Saint Louis hospital in Paris where he was treated with ATRA + arsenic per APPOLO protocol. On J2 of administration of the arsenic trioxide, the patient had an episodes of confusion, hallucination, and alertness disorder. Neurologic examination showed a Glasgow 13/15, with a suspicion of a toxic encephalopathy. The treatment with arsenic trioxide was stopped, Investigation revealed the the level of arsenic trioxide in the blood was 504 nmol/L where the normal level should be N<40. An EEG and a Cerebral MRI were done and showed no adverse pathology. Treatment with succimer 600 mg TID, an antidote for arsenic toxicity, was initiated by the toxicologist. The patient subsequently experienced clinical improvement and a decline in arsenic trioxide blood levels. Arsenic trioxide is not known to cause encephalopathy in leukemic patient. However, this adverse event was reversible after treatment with the antidote. Keywords: APL, acute promyelocytic leukemia, leukemia; arsenic trioxide; retinoic acid; encephalopathy AML-170 Association of Leukocyte Counts With Somatic Mutations and Immunophenotype of Tumor Cells in Acute Myeloid Leukemia (AML) Ksenia Pekhova MD1, Yulia Sidorova MD, PhD2, Ekaterina Zakharko MD2, Valentina Dvirnyk MD, PhD2, Nataliya Severina MD, PhD2, Bella Biderman MD, PhD2, Irina Lukianova MD, PhD2, Anastasiia Kashlakova MD2, Tatiana Obukhova MD, PhD2, Yulia Chabaeva PhD2, Sergei Kulikov PhD2, Hunan Julhakyan MD, PhD2, Andrey Sudarikov MD, PhD2 1Moscow State University, Faculty of Fundamental Medicine, Moscow, Russian Federation. 2National Medical Research Center for Hematology, Moscow, Russian Federation Context: Leukocyte counts at AML onset are associated with certain genetic abnormalities in tumor cells. However, the
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