Azacitidine Causes Prolonged Neutropenia in an Elderly Patient with Primary Myelofibrosis Transformed To Acute Myeloid Leukemia

Volume 1 • Issue 3 • 2012 33 x109/L and blasts were 45% in peripheral blood. He was confirmed to have leukemic transformation of his MF. Due to his age and poor performance status, he was treated with azacitidine 75mg/m2 daily for 7 days starting from 9 December 2010. At the start of treatment, his hemoglobin level was 10.9 g/dL, white cell count was 12.0 x109/L, platelet count was 20 x109/L and 60% blasts were present in peripheral blood. A second cycle of azacitidine of the same dosage and schedule was given from 6 January 2011. After the second cycle of azacitidine, his absolute neutrophil count dropped from normal to 0.32 x109/L with progressive worsening of the neutropenia. His peripheral blood blasts disappeared from 10 February 2011 but his neutropenia persisted. Therefore, further cycle of azacitidine was deemed not suitable. Till 9 March 2011 before his demise, his white cell count was 0.65 x109/L with only few neutrophils detectable in the blood film. His white blood cell, neutrophil and blast counts from the start of azacitidine treatment to his death were illustrated in Figure 1.