From viral encounter to leukemic challenge: A case of isolated molecular relapse in a child with Acute Promyelocytic Leukemia after SARS-CoV-2 infection

Abdolkarimi, Babak and Amanati, Ali and Nikbakht, Sedigheh (2023) From viral encounter to leukemic challenge: A case of isolated molecular relapse in a child with Acute Promyelocytic Leukemia after SARS-CoV-2 infection. From viral encounter to leukemic challenge: A case of isolated molecular relapse in a child with Acute Promyelocytic Leukemia after SARS-CoV-2 infection.

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Abstract

Abstract Introduction Acute promyelocytic leukemia (APL) is an invasive form of acute ‎myeloid leukemia (AML) in which abnormal promyelocytes express in the ‎blood and bone marrow. Promyelocytes can cause serious consequences like ‎bleeding and thrombosis. ‎ Case presentation A 7-year-old boy with APL (M3 AML) experienced isolated molecular ‎relapse after a recent history of SARS-CoV-2 during regular treatment ‎response monitoring. APL relapse was confirmed by presence of the ‎PML/RARalpha transcript in the peripheral blood and bone marrow in ‎repeated sampling. He developed signs of cerebral ischemic stroke during APL ‎relapse which was successfully managed with Low molecular weight heparin ‎‎(LMWH) and corticosteroid. He received an allogenic bone marrow ‎transplantation without any complication during 18-months close follow up.‎ Discussion and Conclusion We present a cerebral ischemic stroke in a pediatric patient who ‎‎experienced an isolated molecular relapse with no clinical or hematological ‎‎relapse after a recent COVID-19 infection‎. Peripheral blood PML-RARA ‎‎transcript ‎may be a useful guide to ‎detect isolated molecular relapse in ‎pediatric APL. The presence of neurological signs and symptoms during ‎immunosuppressive chemotherapy may be the only sign of APL relapse which ‎can be well investigated by MRI±DWI. LMWH is safe treatment strategy until ‎D-‎dimer normalization. COVID-19 infection may play a potential role for ‎pediatric APL relapse as previously described by other respiratory viruses.

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