Refractory Clinical Course of Acute Myeloid Leukemia With t(8; 10; 21)(q22; q22; q22.1): A Case Report and Literature Review of This Variant Form.

Acute myeloid leukemia (AML) with t(8;21)(q22;q22.1)/RUNX1::RUNX1T1 is usually associated with a good prognosis and is categorized as a favorable-risk group in the European Leukemia Net recommendations. A variant form involving a three-way translocation is rarely observed in this AML subtype, and the prognostic impact of this form remains unclear. A 43-year-old man presented with anemia and thrombocytopenia. He had diabetes mellitus and class III obesity according to the WHO criteria. After being diagnosed with AML with t(8;10;21)(q22;q22;q22.1), he received standard induction therapy consisting of cytarabine for seven days and idarubicin for three days, but failed to achieve remission. Reinduction and salvage therapies were also ineffective. This variant form may be associated with a lower likelihood of achieving complete remission (CR) after initial induction therapy. Failure to achieve CR after initial induction therapy in AML is an adverse prognostic factor; therefore, the presence of t(8;21)/RUNX1::RUNX1T1 with three-way translocations may warrant consideration of hematopoietic stem cell transplantation at an earlier stage in the treatment course.