De novo AML spontaneously achieved PR after COVID-19 infection, and CR after reduced dose of azacytidine combined with venetoclax: A case report and literature review.

RATIONALE: Coronavirus disease (COVID-19) infection increases the mortality of patients with hematological malignancies. The optimal treatment for de novo acute myeloid leukemia (AML) patients with severe pneumonia caused by COVID-19 is not clear.

PATIENT CONCERNS: A 59-year-old woman was admitted to our department with fever, cough dyspnea, and thrombocytopenia for 1 week.

DIAGNOSES: The patient was diagnosed with AML associated with a TP53 mutation and complex chromosomal abnormalities by bone marrow examination. In addition, she had severe COVID-19 pneumonia when her AML was diagnosed.

INTERVENTIONS: We delayed leukemia therapy to adequately treat her severe COVID-19 pneumonia. In the therapy for COVID-19 pneumonia, the patient presented with high levels of tumor necrosis factor-α and interleukin 6. Surprisingly, after being treated for severe COVID-19 pneumonia, she obtained partial remission in the absence of leukemia therapy. When the severe COVID-19 pneumonia was under control, the patient achieved complete remission after she received a reduced dose of azacytidine combined with venetoclax for only 1 cycle.

OUTCOMES: After a standard dose of azacytidine combined with venetoclax for 2 cycles, the patient achieved a deep molecular remission. The results of next-generation sequencing analysis indicated that the TP53 mutation turned negative.

LESSONS: This case suggests that azacytidine combined with venetoclax could be a safe and valid option compared with intensive chemotherapy in newly diagnosed AML patients with severe COVID-19 pneumonia. Whether the increased cytokine levels could indicate that COVID-19 infection might have an anti-tumor effect on AML patients remains to be further observed.