Table 1 Oncologic history/summary
January 2017: Skin biopsy showed LCH | |
February 2017: Progressive nausea/diarrhea, weight loss | |
March 2017: EGD - herpes esophagitis, Barrett’s esophagus, Helicobacter pylori gastritis, Langerhans cell sarcoma in stomach/duodenum  Acyclovir full dose, triple therapy (could not tolerate) | |
April 2017: Persistent nausea/emesis, weight loss  EGD: Resolved herpes esophagitis, Barrett’s esophagus, persistent gastritis, Langerhans cell sarcoma in stomach/duodenum  PET/CT: Diffuse uptake in bone marrow, and GI tract  Brain MRI (−)  Bone MRI: Diffuse marrow changes, no bone lesions  Normal CBC, LDH  BMBx (−) | |
May 2017: Cytarabine 100 mg/m2/d × 5 d | |
July 2017: EGD/colonoscopy post C3 - still significant erythema, biopsy (+) | |
August 2017: Improved but persistent symptoms  Skin biopsy - LCH | |
September 2017: C6 - switch to every 2 weeks | |
October 2017: BMBx post C7 – No evidence of disease, dyspoiesis likely from chemo, (−) AML FISH and myeloid NGS | |
November 2017: Right posterior cerebral artery [PCA] thrombus s/p TPA  Circulating blasts: BMBx - acute monoblastic leukemia   Karyotype: 45,XY,der(13;14)(q10;q10)   45,X,der(Y)t(Y;?)(q11.2;?), sl, der(1)t(1;9)(p10;q10), der(8)t(1;8)(q10;p10), del(10)(p11.2)   AML NGS (−), FISH (−) | |
November 2017: 7 + 3 - D15: Recurrent skin lesions  BMBx - persistent AML  Karyotype: 45,XY,der(13;14)(q10;q10)  Skin lesion: Leukemia cutis with LCH  (+) AML NGS PTPN11 mutation  FISH (+) homozygous del 9p21 | |
December 2017: CLAG-M - diplopia on D1  (+) MRI and LP for CSF involvement  LP with IT chemo 2x/week × 6 - (−) first LP  Recovery marrow - CR | |
January 2018: HiDAC 3 g/m2 x C1 + IT | |
February 2018: Cytarabine 2 g/m2 + cladribine 5 mg/m2 + mitoxantrone 10 mg/m2 + IT | |
March 2018: MTX 5 g/m2 + cytarabine 3 g/m2 as a bridge to transplant due to new skin lesions + IT |