Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Acute myeloid leukaemia refractory, Biopsy, COVID-19, Febrile neutropenia, SARS-CoV-2 test
Clinical narrative: Acute myeloid leukaemia refractory; COVID-19 infection; Neutropenic fever; This literature-non-study case was reported in a literature article and describes the occurrence of ACUTE MYELOID LEUKAEMIA REFRACTORY (Acute myeloid leukaemia refractory), COVID-19 (COVID-19 infection) and FEBRILE NEUTROPENIA (Neutropenic fever) in a 68-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 prophylaxis.   LITERATURE REFERENCE:     The patient's past medical history included Acute myeloid leukemia and Chemotherapy since an unknown date.   On an unknown date, the patient received second dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Spikevax) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ACUTE MYELOID LEUKAEMIA REFRACTORY (Acute myeloid leukaemia refractory) (seriousness criterion hospitalization), COVID-19 (COVID-19 infection) (seriousness criterion hospitalization) and FEBRILE NEUTROPENIA (Neutropenic fever) (seriousness criterion hospitalization). The patient was treated with REMDESIVIR for Antiviral treatment, at an unspecified dose and frequency; SOTROVIMAB at an unspecified dose and frequency; CYTARABINE at an unspecified dose and frequency and IDARUBICIN at an unspecified dose and frequency. At the time of the report, ACUTE MYELOID LEUKAEMIA REFRACTORY (Acute myeloid leukaemia refractory), COVID-19 (COVID-19 infection) and FEBRILE NEUTROPENIA (Neutropenic fever) had resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Biopsy: After achieving biopsy confirmed morphologic remission of AML and with neutrophil recovery. On an unknown date, SARS-CoV-2 test: (Positive) mild COVID-19 infection and (Negative) testing negative on polymerase chain reaction test of the nasopharynx.   For mRNA-1273 (Spikevax) (Unknown), the reporter considered ACUTE MYELOID LEUKAEMIA REFRACTORY (Acute myeloid leukaemia refractory), COVID-19 (COVID-19 infection) and FEBRILE NEUTROPENIA (Neutropenic fever) to be related.    No concomitant medication was reported.  This case report on a case of a successfully treated fit elderly woman with refractory acute myeloid leukemia (AML) who also had mild COVID-19 infection and detectable viral load at the time she was found to have recurrent disease.  Patient received antiviral therapy with Remdesivir with resolution of upper respiratory symptoms.  Throughout hospital course, patient remained hemodynamically stable with one episode of neutropenic fever without other identified infections. Symptomatic reactivation of the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) causing COVID-19 was not observed.  This case underlines the importance of considering initiation of timely chemotherapy, although myelosuppressive, in appropriate patients with aggressive hematologic malignancies and concomitant SARS-CoV-2. It demonstrates management of active COVID -19 infection in this group of patients and the dynamics of SARS -CoV-2 viral load during leukemia treatment.  Company comment: This literature non-study case concerns a 68 year old female patient with underlying acute myeloid leukemia(AML), who experienced the unexpected serious (hospitalization) events of Acute myeloid leukaemia refractory, COVID-19 and Febrile neutropenia, unknown days after receiving the second dose of mRNA-1273 vaccine in the COVID-19 vaccination series. The patient received the first dose with the same vaccine on an unknown date. Patient was hospitalized for Acute myeloid leukaemia refractory and also tested positive for SARS-CoV-2. Prior to initiation of reinduction treatment with cytarabine/idarubicin, she received antiviral therapy with Remdesivir with resolution of upper respiratory symptoms. Throughout her hospital course, she remained hemodynamically stable with one episode of neutropenic fever without other identified infections. Symptomatic reactivation of SARS-CoV-2 causing COVID-19 was not observed. After achieving biopsy-confirmed morphologic remission of AML and with neutrophil recovery, the patient gradually cleared the virus, eventually testing negative on polymerase chain reaction test of the nasopharynx. Underlying acute myeloid leukemia could be confounding for the event Acute myeloid leukemia refractory and a risk factor for the event COVID 19. Myelosuppressive chemotherapy could be confounding for the event Febrile neutropenia. No information on other relevant investigations and details pertaining to vaccination schedule was available in the report. The benefit-risk relationship of mRNA-1273 is not affected by this report. Sender's Comments: This literature non-study case concerns a 68-year-old female patient with underlying acute myeloid leukemia (AML), who experienced the unexpected serious (hospitalization) events of Acute myeloid leukemia refractory, COVID-19 and Febrile neutropenia, unknown days after receiving the second dose of mRNA-1273 vaccine in the COVID-19 vaccination series. The patient received the first dose with the same vaccine on an unknown date. Patient was hospitalized for Acute myeloid leukemia refractory and also tested positive for SARS-CoV-2. Prior to initiation of reinduction treatment with cytarabine/idarubicin, she received antiviral therapy with Remdesivir with resolution of upper respiratory symptoms. Throughout her hospital course, she remained hemodynamically stable with one episode of neutropenic fever without other identified infections. Symptomatic reactivation of SARS-CoV-2 causing COVID-19 was not observed. After achieving biopsy-confirmed morphologic remission of AML and with neutrophil recovery, the patient gradually cleared the virus, eventually testing negative on polymerase chain reaction test of the nasopharynx. Underlying acute myeloid leukemia could be confounding for the event Acute myeloid leukaemia refractory and a risk factor for the event COVID 19. Myelosuppressive chemotherapy could be confounding for the event Febrile neutropenia. No information on other relevant investigations and details pertaining to vaccination schedule was available in the report. The benefit-risk relationship of mRNA-1273 is not affected by this report.