CHALLENGING POST-TRANSPLANT COURSE AND MULTIORGAN COMPLICATIONS IN FLT3-POSITIVE ACUTE MYELOID LEUKEMIA

Authors

  • Tara Mojsovska University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Nevenka Ridova University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Olivera Gjeorgjieva Janev University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Merve Purde University Clinic for Hematology - Skopje, Republic of North Macedonia
  • Martin Stojanoski University Clinic for Hematology - Skopje, Republic of North Macedonia
  • Lazar Chadievski University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Zlate Stojanoski University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Svetlana Krstevska Balkanov University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Irina Panovska Stavridis University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Marica Pavkovikj University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Sonja Genadieva Stavrikj University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Aleksandra Pivkova Veljanovska University Clinic for Hematology - Skopje, Republic of North Macedonia Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia

DOI:

https://doi.org/10.53582/1kedyf46

Keywords:

allo-HSCT, FLT3 AML, aGvHD, CMV reactivation, PRES, Thrombotic microangiopathy

Abstract

Introduction: FLT3-mutated acute myeloid leukemia (AML) represents a biologically aggressive subtype associated with high relapse rates and poor overall survival. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the most effective curative therapy, yet it carries substantial risk of transplant-related morbidity and mortality.

Case report: We report the case of a 42-year-old woman diagnosed with FLT3-ITD positive AML who underwent several chemotherapy regimens and achieved complete molecular remission prior to a matched unrelated donor allo-HSCT (9/10, MM in HLA-A). Following myeloablative conditioning (BuCy-ATG), engraftment occurred by day +19. The post-transplant course was complicated by cytomegalovirus (CMV) reactivation (day +28), acute graft-versus-host disease (aGvHD) with severe cutaneous and gastrointestinal involvement (day +31), and transplant-associated thrombotic microangiopathy (TA-TMA) accompanied by hemolysis, thrombocytopenia, and hyperbilirubinemia (day +40). Subsequent neurologic deterioration revealed posterior reversible encephalopathy syndrome (PRES) related to calcineurin-inhibitor toxicity. Despite combined therapy including corticosteroids, plasmapheresis, rituximab, and antiviral treatment, multiorgan dysfunction developed, culminating in fatal cardiorespiratory failure on day +99 post-transplant.

Conclusions: This case underscores the extreme clinical complexity of post-transplant management in FLT3+ AML. The sequential onset of immune-mediated, endothelial, infectious, and neurologic complications highlights the necessity for vigilant monitoring, early diagnostic work-up, and coordinated multidisciplinary care. Proactive risk stratification and individualized prophylactic approaches remain essential to improve survival after allo-HSCT in high-risk AML.

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Published

2026-06-18

Issue

Vol. 6 No. 2 (2026): Acad Med J

Section

Case Reports

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Copyright (c) 2026 Tara Mojsovska, Nevenka Ridova, Olivera Gjeorgjieva Janev, Merve Purde, Martin Stojanoski, Lazar Chadievski, Zlate Stojanoski, Svetlana Krstevska Balkanov, Irina Panovska Stavridis, Marica Pavkovikj, Sonja Genadieva Stavrikj; Aleksandra Pivkova Veljanovska

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