This case of APL with coexisting ider(17) and FLT3-ITD mutations exhibited an aggressive course and resistance to standard treatment. These findings suggest that such patients may require intensified therapeutic strategies and closer monitoring.
After being diagnosed with AML with t(8;10;21)(q22;q22;q22.1), he received standard induction therapy consisting of cytarabine for seven days and idarubicin for three days, but failed to achieve remission. Reinduction and salvage therapies were also ineffective. This variant form may be associated with a lower likelihood of achieving complete remission (CR) after initial induction therapy. Failure to achieve CR after initial induction therapy in AML is an adverse prognostic factor; therefore, the presence of t(8;21)/RUNX1::RUNX1T1 with three-way translocations may warrant consideration of hematopoietic stem cell transplantation at an earlier stage in the treatment course.
Cases of myelofibrosis transforming into MS are extremely rare. The TP53 mutation is a key molecular marker associated with poor tumor prognosis. Because it can be easily mistaken for other tumors, it is crucial to perform relevant examinations and establish a clear diagnosis as early as possible. This facilitates the timely formulation of an appropriate treatment plan and may help prolong the patient's life.