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Case Report Open Access

Acute myeloid leukemia with plasmacytoid dendritic cell proliferation: A case report and literature review

  • Authors:
    • Zhixin Pei
    • Yi Zhang
    • Han Xu
    • Pei Pei
    • Zhengyang Zhang
    • Hongxia Wang
    • Bei Zhang
    • Junjun Bai
    • Yingxin Zhao
    • Jingjing Gu
    • Zhiyu Fang
    • Miaomiao Liu
    • Qinglin Song
  • View Affiliations / Copyright

    Affiliations: Department of Hematology, Jiaozuo People's Hospital, Jiaozuo, Henan 454000, P.R. China, Department of Clinical Pharmacy, Jiaozuo People's Hospital, Jiaozuo, Henan 454000, P.R. China, Jiangsu Key Laboratory of Experimental and Translational Non‑coding RNA Research, Yangzhou University Medical College, Yangzhou, Jiangsu 225009, P.R. China, Laboratory of Hematological Diseases, Jiaozuo People's Hospital, Jiaozuo, Henan 454000, P.R. China, Department of Hematology, Jiaozuo People's Hospital, Jiaozuo, Henan 454000, P.R. China
    Copyright: © Pei et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 456
    |
    Published online on: July 22, 2025
       https://doi.org/10.3892/ol.2025.15202
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Abstract

The present study describes a rare case of plasmacytoid dendritic cell‑associated acute myeloid leukemia (pDC‑AML). A 70‑year‑old male patient was diagnosed with pDC‑AML and underwent induction chemotherapy using the venetoclax + azacitidine (VA) regimen. After 3 weeks of treatment, bone marrow examination indicated a morphologic leukemia‑free state (MLFS); however, the patient experienced persistent cytopenia, which was further complicated by severe pneumonia and gastrointestinal bleeding, both of which improved following treatment. After 3 weeks in MLFS, bone marrow morphology and minimal residual disease analysis revealed a relapse of leukemia. The patient subsequently underwent treatment with selinexor in conjunction with the VA regimen; however, due to severe thrombocytopenia, the family decided to discontinue further treatment. The patient subsequently succumbed shortly after discharge. pDC‑AML is an extremely rare disease characterized by low complete remission rates and a poor prognosis. While the VA regimen demonstrates rapid efficacy and favorable safety in elderly patients, especially those unable to tolerate intensive chemotherapy, the risk of relapse remains substantial. CD123‑targeted therapies may present potential new therapeutic options for this disease. Improving remission rates and extending survival in patients with pDC‑AML remain pressing clinical challenges.
View Figures

Figure 1

Morphological analysis and blast
proportion changes in bone marrow cells before and after treatment.
(A) Morphological examination of bone marrow cells conducted before
and after treatment. Magnification, ×1,000; scale bar, 10 µm. (B)
Proportion of blasts in peripheral blood before and after
treatment. (C) Proportion of blasts in bone marrow before and after
treatment.

Figure 2

Histological examination of bone
marrow via H&E and reticulin fiber staining. (A) H&E
staining of bone marrow. Magnification, ×40 or ×400; scale bars,
500 or 50 µm. (B) Reticulin fiber staining of bone marrow.
Magnification, ×40; scale bar, 50 µm. H&E, hematoxylin and
eosin.

Figure 3

Representative flow cytometry plots
showing both the abnormal myeloid blast population and the pDCs.
(A) Abnormal myeloid population (CD117part+,
HLA-DR+, CD13+, CD33+,
CD38+, CD64+, CD34−). The green
population represents lymphocytes, brown indicates pDCs, red
corresponds to myeloid blasts, blue denotes granulocytes, and
orange represents monocytes. The brown cell populations in the
boxes represent abnormal pDCs. (B) The brown cell populations
abnormal pDCs (CD4+, CD123+,
HLA-DR+, CD36−, CD56−,
CD11c−). Boxed regions were used to highlight
representative areas. pDCs, plasmacytoid dendritic cells.

Figure 4

Analysis of abnormal dendritic cell
proportions before and after treatment. (A) Flow cytometry analysis
of abnormal plasmacytoid dendritic cells (CD4+,
CD123+, HLA-DR+, CD36−,
CD56− and CD11c−) in bone marrow before and
after treatment. Only the CD123+/HLA-DR+
population is presented to highlight the key diagnostic features;
other markers, such as CD4+, are not presented here. The
cell populations in the boxes represent abnormal pDCs. (B) Abnormal
pDCs proportions in bone marrow before and after treatment. (C)
Morphological analysis of abnormal pDCs in bone marrow.
Magnification, ×1,000; scale bar, 10 µm. pDCs, plasmacytoid
dendritic cells.

Figure 5

Timeline of the clinical course. The
timeline summarizes the key events in the patient's clinical
course, including initial presentation, diagnosis, therapeutic
interventions, disease progression and final outcome. AML, acute
myeloid leukemia; pDC, plasmacytoid dendritic cell; VA, venetoclax
+ azacitidine.
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Copy and paste a formatted citation
Spandidos Publications style
Pei Z, Zhang Y, Xu H, Pei P, Zhang Z, Wang H, Zhang B, Bai J, Zhao Y, Gu J, Gu J, et al: Acute myeloid leukemia with plasmacytoid dendritic cell proliferation: A case report and literature review. Oncol Lett 30: 456, 2025.
APA
Pei, Z., Zhang, Y., Xu, H., Pei, P., Zhang, Z., Wang, H. ... Song, Q. (2025). Acute myeloid leukemia with plasmacytoid dendritic cell proliferation: A case report and literature review. Oncology Letters, 30, 456. https://doi.org/10.3892/ol.2025.15202
MLA
Pei, Z., Zhang, Y., Xu, H., Pei, P., Zhang, Z., Wang, H., Zhang, B., Bai, J., Zhao, Y., Gu, J., Fang, Z., Liu, M., Song, Q."Acute myeloid leukemia with plasmacytoid dendritic cell proliferation: A case report and literature review". Oncology Letters 30.4 (2025): 456.
Chicago
Pei, Z., Zhang, Y., Xu, H., Pei, P., Zhang, Z., Wang, H., Zhang, B., Bai, J., Zhao, Y., Gu, J., Fang, Z., Liu, M., Song, Q."Acute myeloid leukemia with plasmacytoid dendritic cell proliferation: A case report and literature review". Oncology Letters 30, no. 4 (2025): 456. https://doi.org/10.3892/ol.2025.15202
Copy and paste a formatted citation
x
Spandidos Publications style
Pei Z, Zhang Y, Xu H, Pei P, Zhang Z, Wang H, Zhang B, Bai J, Zhao Y, Gu J, Gu J, et al: Acute myeloid leukemia with plasmacytoid dendritic cell proliferation: A case report and literature review. Oncol Lett 30: 456, 2025.
APA
Pei, Z., Zhang, Y., Xu, H., Pei, P., Zhang, Z., Wang, H. ... Song, Q. (2025). Acute myeloid leukemia with plasmacytoid dendritic cell proliferation: A case report and literature review. Oncology Letters, 30, 456. https://doi.org/10.3892/ol.2025.15202
MLA
Pei, Z., Zhang, Y., Xu, H., Pei, P., Zhang, Z., Wang, H., Zhang, B., Bai, J., Zhao, Y., Gu, J., Fang, Z., Liu, M., Song, Q."Acute myeloid leukemia with plasmacytoid dendritic cell proliferation: A case report and literature review". Oncology Letters 30.4 (2025): 456.
Chicago
Pei, Z., Zhang, Y., Xu, H., Pei, P., Zhang, Z., Wang, H., Zhang, B., Bai, J., Zhao, Y., Gu, J., Fang, Z., Liu, M., Song, Q."Acute myeloid leukemia with plasmacytoid dendritic cell proliferation: A case report and literature review". Oncology Letters 30, no. 4 (2025): 456. https://doi.org/10.3892/ol.2025.15202
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