Introduction: Solid organ transplant recipients are more prone to developing carcinomas, with the incidence of leukemia being less frequent but still five times more prevalent than in the general population. Acute myeloid leukemia is a rare occurrence in post-transplant recipients as the diagnosis is often misled by cytopenia and infections, both common findings after renal transplantation. This case aimed to highlight the occurrence of such a rare entity of acute myeloid leukemia in post-renal transplant patients.
Method: A 55-year-old female presented with shortness of breath and abdomen pain. The patient had a history of renal transplantation. Post-transplant immunosuppressant medications included tacrolimus and mycophenolate mofetil. For induction therapy, antithymocyte immunoglobulin (Grafalon 300 mg) was administered. The patient also had type 2 diabetes mellitus, hypertension, diabetic retinopathy, and coronary artery disease, having undergone percutaneous transluminal angioplasty in 2014. On admission, patient was conscious with blood pressure 150/90 mmHg, pulse rate 90/min, respiratory rate 20/min, and oxygen saturation 98%. Laboratory investigations revealed hemoglobin 8.8 mg/dL, total leucocyte count 26.06 x10⁹/L, serum urea 25 mg/dL, serum creatinine 0.64 mg/dL, serum lipase 818 U/L, and serum amylase 165 U/L. A high-resolution computed tomography scan of the chest was suggestive of pulmonary edema changes and early pulmonary hypertension. Peripheral blood smear indicated absolute monocytosis with blasts (20%), consistent with acute myeloid leukemia. Genetic testing confirmed acute myeloid leukemia diagnosis, identifying IDH2 p.Arg140Gln and ASXL1 mutations.
Results: The first cycle of chemotherapy with azacitidine (100 mg for 7 days) and venetoclax was initiated. The patient was administered packed red blood cells and single-donor platelet concentrate due to low hemoglobin and platelet counts. The patient was stable at the time of discharge and maintained on tacrolimus 2 mg/day, prednisolone 10 mg, antibiotics, and antifungals along with medications for diabetes and hypertension.
Conclusion: Blood disorders post-transplant are frequently reported but the presence of acute myeloid leukemia is a rare finding. Management strategy in post-transplant acute myeloid leukemia should target reducing the immunosuppressive therapies or replacing myelotoxic agents with lesser toxic drugs. Blood disorders should raise a suspicion of malignancies in post-transplant recipients.