Shweta Bhavsar, MBBS, MD and Lirong Qu, MD, PhD
The patient is a young male child with no significant past medical history presented with fever and sore throat. His complete blood count findings are shown in the table.
The patient had a recent history of multiple bacterial infections over preceding months including clinically diagnosed pneumonia, acute otitis media, streptococcal pharyngitis and pseudomonal cellulitis on his left nipple. He was diagnosed with acute myeloid leukemia with bone marrow examination, which showed 91.7% blasts. The patient failed induction chemotherapy twice with persistence of blasts in the bone marrow and was categorized and treated as Primary Refractory AML. His further hospital course was complicated by total parenteral nutrition dependence, Abiotrophia bacteremia, right atrial mass concerning for endocarditis and multiple worsening aspergillus lung nodules some of which were surgically resected using thoracoscopy. He continued to have persistent fever, pancytopenia and was red blood cell (RBC) and platelet transfusion dependent. He also had persistent severe neutropenia with absolute neutrophil count (ANC) < 0.50X10E+09/L which did not respond to granulocyte colony-stimulating factor (G-CSF). After further chemotherapy, his bone marrow showed no residual leukemic blasts and a bone marrow transplant was planned.
What would be considered as an appropriate therapy for this patient's neutropenia?
DIAGNOSIS and DISCUSSION