Abstract
AML-811: Sustained Remission of NPM1/IDH1-Mutated Acute Myeloid Leukemia Following Allogeneic Hematopoietic Stem Cell Transplant in a Patient With End-Stage Heart Failure Requiring LVAD Support
Clinical lymphoma, myeloma and leukemia, Vol.25(Suppl 1), pp.S460-S461
09/2025
DOI: 10.1016/S2152-2650(25)01731-8
Abstract
Acute myeloid leukemia (AML) in patients with end-stage cardiomyopathy poses a significant therapeutic challenge, particularly when considering curative-intent therapies such as allogeneic hematopoietic stem cell transplantation (HSCT). Data on transplant outcomes in patients with left ventricular ejection fraction (LVEF) <20% are limited, and the long-term feasibility of mechanical circulatory support in leukemia survivors is infrequently reported.
We report a case of a 50-year-old male initially diagnosed with viral myocarditis/cardiomyopathy at the age of 43, presenting with fever and fatigue. Cardiac catheterization showed non-obstructive coronary disease, with an LVEF of 20% to 25%. His functional status recovered, but LVEF remained low. Three years later, he developed anemia, circulating blasts, and was diagnosed with NPM1/IDH1-mutated AML in 2017. Due to cardiac compromise, anthracycline was deferred. He received FLAG induction, followed by four cycles of HiDAC consolidation. Complete remission (CR1) lasted 7 months before relapse, successfully salvaged with FLAG. He was considered for HSCT after achieving CR2, but deferred for cardiac comorbidities, CR2 lasted 6 months before the second relapse. Salvage azacitidine/venetoclax was started and CR3 was achieved, although measurable residual disease (MRD) remained detectable by NPM1 PCR. He proceeded to reduced-intensity conditioning HSCT using busulfan/fludarabine from a match-unrelated donor with ATG/tacrolimus/methotrexate for graft-versus-host disease (GVHD) prophylaxis in 2019. Post-transplant complications included multifocal pneumonia, recurrent septic/cardiogenic shock, and ventricular tachycardia (VT) storm, requiring prolonged ICU stay. One-year post-HSCT, he developed chronic GVHD involving the eyes, mouth, and lung, but AML has remained in CR, MRD negative by NPM1 PCR. In 2022, due to recurrent ventricular arrhythmias and cardiogenic shock, he underwent the implantation of a left ventricular assist device (LVAD) with no further admission for acute decompensated heart failure. He continues to do well clinically, with no evidence of AML relapse five years post-HSCT.
This case illustrates the practicality of HSCT in AML patients with severe cardiac dysfunction. Despite advanced heart failure and the need for LVAD placement, he was able to achieve long-term remission from AML based on MRD monitoring and careful survivorship care. Multidisciplinary collaboration in oncology, cardiology, and transplant medicine was critical to this patient's outcome.
Details
- Title: Subtitle
- AML-811: Sustained Remission of NPM1/IDH1-Mutated Acute Myeloid Leukemia Following Allogeneic Hematopoietic Stem Cell Transplant in a Patient With End-Stage Heart Failure Requiring LVAD Support
- Creators
- Chalothorn Wannaphut - University of Hawaii SystemManasawee Tanariyakul - University of Hawaii SystemMargarida Magalhaes-Silverman - University of IowaKittika Poonsombudlert - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Clinical lymphoma, myeloma and leukemia, Vol.25(Suppl 1), pp.S460-S461
- DOI
- 10.1016/S2152-2650(25)01731-8
- ISSN
- 2152-2650
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 09/2025
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984949229302771
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