Fellow, Dept of Hematopathology 1515 Holcombe Blvd, Unit 072

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Fellow, Dept of Hematopathology 1515 Holcombe Blvd, Unit 072 Huifei Liu, MD, PhD Fellow, Dept of Hematopathology 1515 Holcombe Blvd, Unit 072 The University of Texas at MD Anderson Cancer Center Houston, TX 77030

Clinical History 71-year-old man Anemia for several months with recent progressive shortness of breath PMH: asthma, hypertension, BPH, hyperlipidemia Testosterone supplement since 4/2013 Splenomegaly

PB: Blasts (18%) with eosinophilia (29%) and Anemia

PB: Atypical eosinophil

BM: 30% Blasts with 15% eosinophils

BM: ↑Immature Cells, Eosinophils, Megakaryocytyes

BM: Megakaryocytic Hyperplasia/Dysplasia

Flow Cytometry

Flow Cytometry

Immunophenotype of Blasts CD34+/CD117+/CD45+ CD13+/CD33+/CD38+/HLADR+ CD4dim/CD5dim/CD7p+/CD25p+/CD56+ MPO− CD2−/CD3−/CD10−/CD14−/CD15− CD19−/CD123−/TdT−

Cytogenetics & Molecular Diagnostics 45,XY,-7[20] FLT3 ITD ASXL1 PTPN11 PDGFRA rearrangement (-) PDGFRB rearrangement (-) BCR/ABL1 (-) CHIC2 deletion (-)

Diagnosis ACUTE MYELOID LEUKEMIA WITH FLT3-ITD MUTATION IN A BACKGROUND OF MARKED EOSINOPHILIA AND MARKED MEGAKARYOCYTIC HYPERPLASIA

Discussion 1+1=? 1+1+1=? 1+1+1+……=? How does multiple mutations interact to shape clinical presentation and treatment responses? 1+1=? 1+1+1=? 1+1+1+……=?