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

Abstract

Rationale Acute myeloid leukemia (AML), in patients with coronary heart disease (CHD) and treated percutaneous coronary intervention (PCI), is rarely seen in clinic. There are few similar cases reported, and there are no evidence-based medicine guidelines for the treatment. Patient concerns A 52-year-old man was diagnosed with coronary atherosclerotic heart disease in November 2011, and received a stent placement in the left anterior descending coronary artery 1 year later. One day after the surgery, his laboratory tests showed pancytopenia. Diagnoses Based on precise diagnosis of leukemia, namely cell morphology, immunology, cytogenetics, and molecular biological typing, the patient was diagnosed with AML-M2. Interventions The patient received idarubicin with cytarabine in 1st cycles, and single cytarabine regimen was used in 2nd and 3rd cycles for the accumulative toxicity of idarubicin in postinduction chemotherapy. Meanwhile, staged-treatment strategy was implemented by using antiplatelet drugs during different chemotherapy phases, and personalized pharmaceutical care on the basis of the recognition of potential adverse effects of chemotherapy regimen. Outcomes Until now, the disease-free survival in the patient has been over 6 years, and he is still followed up in clinic. Lessons Although leukemia accompanied with coronary heart disease, even after receiving the coronary stenting therapy is rarely seen in clinic, the treatment with antiplatelet drugs for post chemotherapy patients with coronary disease is necessary. Clinical pharmacists are supposed to be more proficient in developing personalized drug treatment strategies, especially maintaining the balance between the effect and the risk in difficult and complex cases.

Dual anti-platelet therapy following percutaneous coronary intervention in a population of patients with thrombocytopenia at baseline: a meta-analysis

“…For example, following PCI in a patient with acute myeloid leukemia receiving chemotherapy [25], DAPT was prescribed but the duration was adapted based on the patient's tolerability and circumstance. A personalized treatment strategy should be thought to maintain a balance between the effect and risk for bleeding [26]. Similarly, in cirrhotic patients with coronary artery disease, DAPT while reducing the risk of recurrent myocardial infarction, it was associated with a higher gastrointestinal bleeding [27] which might later result in discontinuation or modification of this antiplatelet regimen.…”