Challenging Preservation of the Renal Function in a Case of an Acute Erythroid Leukemia (Fab M6) Known with Moderate-to-Severe Chronic Kidney Disease

Acute erythroid leukemia (AEL) is a subtype of Acute Myeloid Leukemia (AML), comprising less than 5% of AML cases, characterized by erythroblastic proliferation. It’s a rare and aggressive form of acute leukemia whose biology remains poorly described, and there are many controversies around diagnosis influencing prognostic and therapeutic challenges. The average survival time for this type of Leukemia is 3 months. We present a unique case of a patient already known to have Chronic Kidney Disease stage G4, diagnosed with Acute Erythroid Leukemia (Fab M6), confirmed by Flow-Cytometry (infiltration of 93% erythroblasts in the Bone Marrow), who underwent specific chemotherapy (Azacitidine and Venetoclax) for 4 months. Due to severe pancytopenia and the presence of leukemic hiatus, it was challenging to avoid hemodialysis/hemofiltration, overcome metabolic acidosis and hyperuricemia, preserve serum creatinine levels at acceptable levels, and maintain hydroelectrolytic balance. All drug dosages (chemotherapy and supportive treatment) were adapted to the patient’s renal function.