Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2023; 11(21): 5129-5135
Published online Jul 26, 2023. doi: 10.12998/wjcc.v11.i21.5129
Acute myelomonocytic leukemia and T-lymphoblastic lymphoma as simultaneous bilineage hematologic malignancy treated with decitabine: A case report
So-Yeon Jeon, Na-Ri Lee, Seungah Cha, Ho-Young Yhim, Jae-Yong Kwak, Kyu Yun Jang, Namsu Kim, Yong Gon Cho, Chang-Hoon Lee
So-Yeon Jeon, Na-Ri Lee, Seungah Cha, Ho-Young Yhim, Jae-Yong Kwak, Chang-Hoon Lee, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju 54907, South Korea
Kyu Yun Jang, Department of Pathology, Jeonbuk National University Medical School, Jeonju 54907, South Korea
Namsu Kim, Yong Gon Cho, Department of Laboratory Medicine, Jeonbuk National University Medical School, Jeonju 54907, South Korea
Author contributions: Jeon SY wrote the manuscript; Lee NR, Cha S, Jang KY, Kim N, and Cho YG collected and validated the data; Yhim HY and Kwak JY revised the manuscript; Lee CH was in charge of patient treatment and designed the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Hoon Lee, MD, PhD, Assistant Professor, Doctor, Department of Internal Medicine, Jeonbuk National University Medical School, 20 Geonji-ro, Jeonju 54907, South Korea. rednose2000@hanmail.net
Received: April 14, 2023
Peer-review started: April 14, 2023
First decision: May 19, 2023
Revised: June 8, 2023
Accepted: June 30, 2023
Article in press: June 30, 2023
Published online: July 26, 2023
Processing time: 103 Days and 16 Hours
Abstract
BACKGROUND

Simultaneous bilineage hematologic malignancies are rare; however, several cases of acute myeloid leukemia (AML) and T-lymphoblastic lymphoma (T-LBL) co-occurrence have been reported. A standard treatment for simultaneous AML and T-LBL has not yet been established, and its prognosis is very poor. Further studies to develop standard treatments are required to increase patient survival rates.

CASE SUMMARY

A 69-year-old man complaining of pleuritic chest pain visited the emergency room. Computed tomography revealed multiple enlarged lymph nodes (LNs) in the neck and groin and pulmonary thromboembolism with pulmonary infarction. Furthermore, a peripheral blood smear performed due to leukocytosis revealed circulating blasts. Acute myelomonocytic leukemia (AMML) was diagnosed after bone marrow examination, and T-LBL positivity for terminal deoxynucleotidyl transferase, cluster of differentiation (CD)34, and CD4 was confirmed by cervical LN biopsy. Decitabine and dexamethasone were administered because he could not receive intensive chemotherapy due to poor performance status. Complete remission of AMML and T-LBL was achieved after 4 cycles of decitabine plus dexamethasone.

CONCLUSION

We report the therapeutic effect of decitabine, a hypomethylating agent (HMA), in patients with concurrent bilineage hematologic malignancies and suggest that further studies are required to evaluate the therapeutic effect of HMAs on both lymphoid and bilineage hematologic malignancies.

Keywords: Simultaneous bilineage hematologic malignancies; Acute myelomonocytic leukemia; T-lymphoblastic lymphoma; Decitabine; Pulmonary thromboembolism; Case report

Core Tip: Simultaneous bilineage hematologic malignancies are rare. Here, we report an unusual case of concurrent acute myelomonocytic leukemia (AMML) and T-lymphoblastic lymphoma (T-LBL), treated with decitabine. After the fourth cycle of decitabine and dexamethasone administration, a patient achieved complete remission of AMML and T-LBL. Hypomethylating agents (HMAs) have been approved for the treatment of myelodysplastic syndrome and intensive induction-ineligible acute myeloid leukemia; however, their therapeutic effect on lymphoid malignancy has not yet been sufficiently investigated. This case suggests the need of further studies to evaluate the therapeutic effects of HMAs on lymphoid and bilineage hematologic malignancies.