Date

Symptoms

Analyses

Treatment

Notes

24 Nov 2012

Moderately differentiated SCC in the left soft palate (ulceration and hard osteonecrosis of soft palate) + partial loss of vision in the left eye +

pancytopenia [Leucopenia (WBC 2.6 × 109/l), neutropenia (1.2 × 109/l); anemia (Hgb 7.9 g/dl);

thrombocytopenia (Plt 46 × 109/l).

Vit(B12) 138 pg/ml

(normal value 243 - 1100), and Vit(B9) 5.47 ng/ml (normal 2.8 - 21).

・ Bone marrow (BM) smear showed almost 20% of blats

8 cycles

radiotherapy for 2 months

Stooped radiotherapy because the

pancytopenia continues (WBC 1.9 × 109/l), neutropenia (1.1 × 109/l); Hgb 10.6 g/dl);

Plt 39 × 109/l).

・ Vit(B12) deficiency was treated but still suffered from pancytopenia.

03 Dec 2013

Peripheral blood (PB) showed

pancytopenia (WBC 2.6 × 109/l), neutropenia (1.2 × 109/l);

Hgb 7.9 g/dl); Plt 46 × 109/l).

Cytogenetic analyses and immunophenotyping were done at this point.

・ Banding cytogenetics revealed a karyotype 46,XY,der(7)t(1;7)(?;?)[11]/ 46,XY[9]

・ Immunophenotyping result suggested RAEB-2 according to WHO classification.

・ He received several blood Transfusions.

15 Dec 2013

Peripheral blood (PB) showed

pancytopenia.

Thalidomide (50mg three times per day) for two weeks

31 Dec 2013

Intolerance of Thalidomide drug.

Severe nausea, Syncope, Neuropathy.

He received blood transfusions.

07 Jan 2014

He received several blood

transfusions. PB showed

pancytopenia (WBC 1.6 × 109/l), neutropenia (1.1 × 109/l); Hgb 6.7 g/dl); Plt 92 × 109/l).

Suggested Vidaza (Azacitidine)

No Azacitidine treatment because the political situation in his country.

11 Feb 2014

He received

Azacitidine

(75 mg/m2)

(first cycle in the first day)

He received several blood Transfusions. PB showed pancytopenia (WBC 1.8 × 109/l), neutropenia (1.1 × 109/l); Hgb 7.4 g/dl);

Plt 67 × 109/l).

Later he had bilateral pleural effusion, and heavy ascites.

24 Feb 2014

The patient was lost during follow-up.