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Case Reports in Hematology
Volume 2013, Article ID 896394, 3 pages
Case Report

Early Death in Two Patients with Acute Promyelocytic Leukemia Presenting the bcr3 Isoform, FLT3-ITD Mutation, and Elevated WT1 Level

1Hematology Unit and Bone Marrow Transplantation Center, “R. Binaghi” Hospital, Via Is Guadazzonis 3, 09126 Cagliari, Italy
2Department of Medical Sciences, University of Cagliari, 09100 Cagliari, Italy

Received 8 May 2013; Accepted 29 May 2013

Academic Editors: U. Dasgupta, N. Hamerschlak, and R. Tiu

Copyright © 2013 Marianna Greco et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Despite major advances in the treatment of acute promyelocytic leukemia (APL), the problem of early death (ED) remains unsolved. Alongside the currently known clinical and hematological risk factors, prognostic significance has been attributed to internal tandem duplication mutations of the fms-like tyrosine kinase-3 (FLT3-ITD), hypogranular variant morphology, and the bcr-3 isoform of PML-RARα. We describe premature death of two patients with the hypogranular variant of APL who presented remarkably high expression levels of Wilms' tumor gene (WT1). Our results point to WT1 as an important prognostic factor of ED that needs to be promptly evaluated in all newly diagnosed cases of APL.