Type of cancer: Pediatric acute myeloid leukemia (AML) with CBFA2T3::GLIS2 fusion / RAM phenotype. She also...

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Type of cancer: Pediatric acute myeloid leukemia (AML) with CBFA2T3::GLIS2 fusion / RAM phenotype. She also presented with two myeloid sarcomas (chloromas), including orbital/head involvement. CNS/spinal fluid involvement has reportedly been negative so far. * Pathology / biomarkers: * CBFA2T3::GLIS2 fusion positive * RAM phenotype AML * FOLR1 (FRα / “FLOR1”) expression has been discussed because of potential eligibility for FOLR1-targeted therapies (STRO/Luvelta, CAR-T approaches), but current MRD findings regarding FOLR1 were considered inconclusive due to limited marrow recovery/sample quality. * PCR became non-detectable after first induction cycle. * MRD flow cytometry after induction was considered inconclusive/suboptimal because of hypocellular marrow and inadequate myeloid recovery; no definitive leukemic population identified. * Current / past treatments: * Induction chemotherapy with ADE (cytarabine + daunorubicin + etoposide) * Decitabine primer prior to ADE * Multiple supportive transfusions during count suppression * Broad-spectrum antibiotics during neutropenia (Zosyn discussed recently) * Discussions have occurred regarding possible future FLAG-IDA + Venetoclax if additional chemotherapy is needed. * Bone marrow transplant (BMT) is being discussed as a likely major component of treatment strategy depending on repeat marrow/MRD results. * STRO/Luvelta and future CAR-T strategies were discussed with experts, but STRO is currently unavailable because the company halted the program. * Recent test results / scans: * MRI showed dramatic improvement/shrinkage of the orbital/head chloromas after first induction. * PCR after induction became non-detectable. * Repeat marrow after induction showed inconclusive MRD due to low cellularity/poor myeloid recovery, though no definitive leukemia population was seen. * Current blood count recovery: * ANC recently rose from ~50 to ~120 * Platelets increased from ~45 to ~76 * Hemoglobin around ~7.8 * Clinical status currently much improved: * playful * active * eating/drinking better * afebrile. * What oncology team has mentioned about next steps: * Repeat bone marrow biopsy/aspirate planned Tuesday to reassess MRD/PCR and marrow recovery. * If counts continue improving and she remains stable, possible temporary discharge home before returning for marrow testing. * Team is discussing whether next step would be: * proceeding toward transplant if disease burden remains extremely low, * or additional chemotherapy (likely FLAG-IDA, potentially with Venetoclax). * Stanford team has been communicating with Seattle Children’s/Dr. [removed] and Dr. [removed] regarding subtype-specific strategy and evolving treatment approaches.