A Rare Case of Acute Promyelocytic Leukemia with ider(17)(q10)t(15;17)(q22;q21) and FLT3-ITD Mutation

BACKGROUND: Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia characterized by the t(15;17)(q22;q21) translocation. Although it typically responds well to therapy, certain genetic aberrations, including ider(17)(q10)t(15;17)(q22;q21) and FLT3-ITD mutations, have unclear prognostic implications. METHODS: A 61-year-old female patient presented with dizziness and persistent bruising. Laboratory and imaging studies revealed coagulopathy and intracranial hemorrhage. Morphological, immunophenotypic, cytogenetic, molecular, and FISH analyses confirmed APL with both ider(17)(q10)t(15;17)(q22;q21) and FLT3-ITD mutation. RESULTS: Despite standard ATRA and idarubicin induction therapy, there was no improvement in leukemic burden, and the patient succumbed to worsening hemorrhage one week after emergency surgery. CONCLUSIONS: This case of APL with coexisting ider(17) and FLT3-ITD mutations exhibited an aggressive course and resistance to standard treatment. These findings suggest that such patients may require intensified therapeutic strategies and closer monitoring.