A 38-year-old man with complaints of easy fatigability, dyspnea, and intermittent fever was referred with a suspicion of APL for molecular testing. FISH detected a variant RARA translocation which was confirmed to be ZBTB16-RARA by PCR. However, the morphological features differed from the previous case. The abnormal promyelocytes with regular nuclei showed the presence of Auer rods but had abundant cytoplasm with scanty granularity along with the presence of Pelger-like neutrophils (Figure 2, C & D).
The patient received ATO based induction therapy but responded poorly and failed to achieve remission. The post induction Ct value (25.02) by RT-qPCR was similar to the baseline one (23.65). However, the patient died shortly after completing two months of therapy.