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Papers by Shams ElDoha Zaiema

Research paper thumbnail of Illuminating the impact of CD38-induced adenosine formation in B-cell lymphoma

Scientific Reports , 2025

Research paper thumbnail of Lupus activity in lupus nephritis patients with end-stage renal disease treated with hemodialysis

Research paper thumbnail of Unpredicted transformation of acute myeloid leukemia with translocation (16;16) (p13; q22): a case report and review of the literature

˜The œEgyptian Journal of Internal Medicine/The Egyptian Journal of Internal Medicine, Mar 5, 2024

Research paper thumbnail of Insight into antiphospholipid syndrome: the role and clinical utility of neutrophils extracellular traps formation

Thrombosis journal, Mar 28, 2024

Research paper thumbnail of Erythroferrone, the new iron regulator: evaluation of its levels in Egyptian patients with beta thalassemia

Annals of Hematology, 2019

Since iron overload is the commonest cause of morbidity and mortality in β thalassemia major (β-T... more Since iron overload is the commonest cause of morbidity and mortality in β thalassemia major (β-TM), it represents one major target in therapeutic management of the disease. The recently discovered erythroid regulator, erythroferrone (ERFE), governed by high levels of erythropoietin, was found to suppress hepcidin expression, thus increasing iron availability for developing erythroid progenitors. We aimed to investigate ERFE levels in Egyptian β-TM patients as an attempt to understand its role in the prediction of iron overload states. Our study included 70 β-TM patients, divided into two subgroups according to the degree of iron overload, and 30 sex and age-matched healthy subjects. ERFE gene expression was analyzed by quantitative real-time polymerase chain reaction (qRT-PCR), and serum hepcidin was measured using enzyme-linked immunosorbent assay (ELISA) technique. Both ERFE gene expression levels and transferrin saturation (TS%) values were able to discriminate among cases with different degrees of iron overload, in contrast to hepcidin. TS% was acknowledged as the best predictor of iron overload (AUC 0.893) in comparison with serum hepcidin and ERFE gene levels (AUC 0.807 and 0.677, respectively), and ERFE gene expression was an independent predictor for the estimated TS%. In conclusion, we suggest that using the ERFE gene expression, combined with serum hepcidin estimation, can substantiate the role of estimated TS% as a promising tool in screening for iron overload in β-TM patients.

Research paper thumbnail of Value of Leucocyte Cell Population Data from Sysmex XN-1000 in Early Detection of Acute Leukemia

Ain Shams Medical Journal

Background: Among the more complex tests for the diagnostic workup of acute leukemia (AL), automa... more Background: Among the more complex tests for the diagnostic workup of acute leukemia (AL), automated hematology cell counters provide leucocyte cell population data (CPD) parameters along with the basic complete blood count (CBC) that have the ability to recognize morphological changes in these cells. Aim of the work: Assessment of the efficiency of CPD research parameters obtained by Sysmex XN-1000 auto-analyzer to predict the diagnosis of AL and its subclassification into acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Patients and methods: Cell population data (CPD) parameters from 103 newly diagnosed AL samples were processed on Sysmex XN-1000 auto-analyzer and compared with 101 age-matched controls (51 healthy and 50 reactive subjects). Results: We found significant differences in many CPD neutrophilic, monocytic, and lymphocytic population together with parameters between AL patients and both healthy and reactive controls, particularly those related to the width of dispersion of the parameters related to neutrophil side scatter intensity, neutrophil forward scatter intensity, lymphocyte side scatter intensity, monocyte side scatter intensity and monocyte side fluorescence intensity. To differentiate AML from ALL, the most significant differences were found in the median values of monocyte side scatter and monocyte side fluorescence along with the neutrophil forward scatter area distribution width and neutrophil forward scatter. Conclusion: The CPD parameters generated from Sysmex XN-1000 auto-analyzer during CBC analysis could be a useful tool for the prediction of AL and its lineage.

Research paper thumbnail of Insight into antiphospholipid syndrome: the role and clinical utility of neutrophils extracellular traps formation

Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive c... more Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive complications and pregnancy loss in the absence of definite etiology. Most research focuses on the laboratory detection and clinical features of APLS, but its precise etiology remains to be deeply explored. NETosis is a newly developed theory in the pathophysiology of APLS which may serve as the missing bridge between coagulation and inflammation reaching the disease progression and severity. We aimed in this study to navigate the prognostic role of NETosis in thrombotic APLS. Our study included 49 newly diagnosed APLS patients (both 1ry and 2ry) who met clinical and laboratory criteria as per the international consensus statement on the update of the classification criteria for definite APLS and were sub-classified according to the occurrence of thrombotic events in thrombotic and non-thrombotic types. In addition, 20 sex and age-matched reactive subjects and 20 sex and age-matched healthy volunteer controls were enrolled. NETosis formation was assessed by measuring serum Myeloperoxidase (MPO) and Histones level using the enzyme-linked immunosorbent assay (ELISA) technique. Both MPO and Histones levels were able to discriminate among APLS cases from normal controls, showing significant cutoffs of > 2.09 ng/ml for MPO and > 1.45 ng/ml for Histones (AUC values were 0.987and 1.000, respectively). These values can be used as predictors for NETosis pathophysiology in APLS patients. Additionally, these markers demonstrated a significant association with several prognostic indicators, including thrombosis, higher PT and INR, and lower hemoglobin (Hb) levels which are supposed to be ameliorated by using NETs inhibitors. In conclusion, we suggest that measuring NETosis markers, MPO, and Histones, in the early course of APLS using proposed cutoff values will facilitate the timely initiation of anti-NETosis therapy and improve the overall prognosis, particularly for patients with thrombotic APLS.

Research paper thumbnail of Insight into antiphospholipid syndrome: the role and clinical utility of neutrophils extracellular traps formation

Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive c... more Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive complications and pregnancy loss in the absence of definite etiology. Most research focuses on the laboratory detection and clinical features of APLS, but its precise etiology remains to be deeply explored. NETosis is a newly developed theory in the pathophysiology of APLS which may serve as the missing bridge between coagulation and inflammation reaching the disease progression and severity. We aimed in this study to navigate the prognostic role of NETosis in thrombotic APLS. Our study included 49 newly diagnosed APLS patients (both 1ry and 2ry) who met clinical and laboratory criteria as per the international consensus statement on the update of the classification criteria for definite APLS and were sub-classified according to the occurrence of thrombotic events in thrombotic and non-thrombotic types. In addition, 20 sex and age-matched reactive subjects and 20 sex and age-matched healthy volunteer controls were enrolled. NETosis formation was assessed by measuring serum Myeloperoxidase (MPO) and Histones level using the enzyme-linked immunosorbent assay (ELISA) technique. Both MPO and Histones levels were able to discriminate among APLS cases from normal controls, showing significant cutoffs of > 2.09 ng/ml for MPO and > 1.45 ng/ml for Histones (AUC values were 0.987and 1.000, respectively). These values can be used as predictors for NETosis pathophysiology in APLS patients. Additionally, these markers demonstrated a significant association with several prognostic indicators, including thrombosis, higher PT and INR, and lower hemoglobin (Hb) levels which are supposed to be ameliorated by using NETs inhibitors. In conclusion, we suggest that measuring NETosis markers, MPO, and Histones, in the early course of APLS using proposed cutoff values will facilitate the timely initiation of anti-NETosis therapy and improve the overall prognosis, particularly for patients with thrombotic APLS.

Research paper thumbnail of VALUE OF LEUCOCYTE CELL POPULATION DATA FROM SYSMEX XN-1000 IN EARLY DETECTION OF ACUTE LEUKEMIA

Background: Among the more complex tests for the diagnostic workup of acute leukemia (AL), automa... more Background: Among the more complex tests for the diagnostic workup of acute leukemia (AL), automated hematology cell counters provide leucocyte cell population data (CPD) parameters along with the basic complete blood count (CBC) that have the ability to recognize morphological changes in these cells. Aim of the work: Assessment of the efficiency of CPD research parameters obtained by Sysmex XN-1000 auto-analyzer to predict the diagnosis of AL and its subclassification into acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Patients and methods: Cell population data (CPD) parameters from 103 newly diagnosed AL samples were processed on Sysmex XN-1000 auto-analyzer and compared with 101 age-matched controls (51 healthy and 50 reactive subjects). Results: We found significant differences in many CPD neutrophilic, monocytic, and lymphocytic population together with parameters between AL patients and both healthy and reactive controls, particularly those related to the width of dispersion of the parameters related to neutrophil side scatter intensity, neutrophil forward scatter intensity, lymphocyte side scatter intensity, monocyte side scatter intensity and monocyte side fluorescence intensity. To differentiate AML from ALL, the most significant differences were found in the median values of monocyte side scatter and monocyte side fluorescence along with the neutrophil forward scatter area distribution width and neutrophil forward scatter. Conclusion: The CPD parameters generated from Sysmex XN-1000 auto-analyzer during CBC analysis could be a useful tool for the prediction of AL and its lineage.

Research paper thumbnail of Erythroferrone, the new iron regulator: evaluation of its levels in Egyptian patients with beta thalassemia

Erythroferrone, the new iron regulator: evaluation of its levels in Egyptian patients with beta thalassemia, 2020

Since iron overload is the commonest cause of morbidity and mortality in β thalassemia major (β-T... more Since iron overload is the commonest cause of morbidity and mortality in β thalassemia major (β-TM), it represents one major target in therapeutic management of the disease. The recently discovered erythroid regulator, erythroferrone (ERFE), governed by high levels of erythropoietin, was found to suppress hepcidin expression, thus increasing iron availability for developing erythroid progenitors. We aimed to investigate ERFE levels in Egyptian β-TM patients as an attempt to understand its role in the prediction of iron overload states. Our study included 70 β-TM patients, divided into two subgroups according to the degree of iron overload, and 30 sex and age-matched healthy subjects. ERFE gene expression was analyzed by quantitative real-time polymerase chain reaction (qRT-PCR), and serum hepcidin was measured using enzyme-linked immunosorbent assay (ELISA) technique. Both ERFE gene expression levels and transferrin saturation (TS%) values were able to discriminate among cases with different degrees of iron overload, in contrast to hepcidin. TS% was acknowledged as the best predictor of iron overload (AUC 0.893) in comparison with serum hepcidin and ERFE gene levels (AUC 0.807 and 0.677, respectively), and ERFE gene expression was an independent predictor for the estimated TS%. In conclusion, we suggest that using the ERFE gene expression, combined with serum hepcidin estimation, can substantiate the role of estimated TS% as a promising tool in screening for iron overload in β-TM patients.

Research paper thumbnail of Unpredicted transformation of acute myeloid leukemia with translocation (16;16) (p13; q22): a case report and review of the literature

Unpredicted transformation of acute myeloid leukemia with translocation (16;16) (p13; q22): a case report and review of the literature, 2024

Introduction The transformation of acute myeloid leukemia with translocation (16;16) (p13; q22) f... more Introduction The transformation of acute myeloid leukemia with translocation (16;16) (p13; q22) from AML M2 to acute monocytic leukemia (AML M5) during therapy is a rare clinical occurrence, and this is the first time it has been reported. Clinical complain A 19-year-old male patient was admitted for severe fatigue with anemic manifestation and weight loss, for more than 1 month, with exacerbation of the condition in the last 2 days. Diagnosis A primary diagnosis was made for AML M2 with t (16;16) (p13; q22) established on bone marrow (BM) morphology. A consequential detection of FLT-3 ITD mutation was done. At day 28 follow-up after induction and maintenance therapy, the diagnosis of AML M2 was maintained with a high bone marrow (BM) blast count, prompting the initiation of a more aggressive treatment protocol. After 1 month of implementing the recent protocol, the patient remains morphologically resistant with a notable transformation of bone marrow infiltration by an abnormal monocytic population (monoblasts and promonocytes). The final diagnosis of transforming FLT3-mutated AML with t (16;16) (p13; q22) was established. Intervention After the initial diagnosis of AML M2 with t (16;16) (p13; q22), the patient received the 3 + 7 induction protocol. The 2nd induction protocol initiated after the second evaluation and morphological resistance was the FLAG Adrian protocol. The 3rd protocol after transformation to AML M5 was 1 cycle of the MEC protocol. Anti-FLT3 treatment was considered. Outcomes The patient was maintained on the 3rd protocol of chemotherapy. Unfortunately, he was admitted to the ICU unit complaining of neutropenic fever and severe sepsis where he died before final re-evaluation and the anti-FLT3 treatment initiation. Conclusion AML with t (16;16) (p13; q22) characterized by favorable outcome. However, identifying additional chromosome abnormality or genetic aberration, especially FLT3 gene mutation, is recognized as an important factor influencing final disease outcome. Therefore, early detection of FLT3 mutations will allow comprehensive disease course prediction and targeted therapy that might achieve longer and more durable remissions.

Research paper thumbnail of Illuminating the impact of CD38-induced adenosine formation in B-cell lymphoma

Scientific Reports , 2025

Research paper thumbnail of Lupus activity in lupus nephritis patients with end-stage renal disease treated with hemodialysis

Research paper thumbnail of Unpredicted transformation of acute myeloid leukemia with translocation (16;16) (p13; q22): a case report and review of the literature

˜The œEgyptian Journal of Internal Medicine/The Egyptian Journal of Internal Medicine, Mar 5, 2024

Research paper thumbnail of Insight into antiphospholipid syndrome: the role and clinical utility of neutrophils extracellular traps formation

Thrombosis journal, Mar 28, 2024

Research paper thumbnail of Erythroferrone, the new iron regulator: evaluation of its levels in Egyptian patients with beta thalassemia

Annals of Hematology, 2019

Since iron overload is the commonest cause of morbidity and mortality in β thalassemia major (β-T... more Since iron overload is the commonest cause of morbidity and mortality in β thalassemia major (β-TM), it represents one major target in therapeutic management of the disease. The recently discovered erythroid regulator, erythroferrone (ERFE), governed by high levels of erythropoietin, was found to suppress hepcidin expression, thus increasing iron availability for developing erythroid progenitors. We aimed to investigate ERFE levels in Egyptian β-TM patients as an attempt to understand its role in the prediction of iron overload states. Our study included 70 β-TM patients, divided into two subgroups according to the degree of iron overload, and 30 sex and age-matched healthy subjects. ERFE gene expression was analyzed by quantitative real-time polymerase chain reaction (qRT-PCR), and serum hepcidin was measured using enzyme-linked immunosorbent assay (ELISA) technique. Both ERFE gene expression levels and transferrin saturation (TS%) values were able to discriminate among cases with different degrees of iron overload, in contrast to hepcidin. TS% was acknowledged as the best predictor of iron overload (AUC 0.893) in comparison with serum hepcidin and ERFE gene levels (AUC 0.807 and 0.677, respectively), and ERFE gene expression was an independent predictor for the estimated TS%. In conclusion, we suggest that using the ERFE gene expression, combined with serum hepcidin estimation, can substantiate the role of estimated TS% as a promising tool in screening for iron overload in β-TM patients.

Research paper thumbnail of Value of Leucocyte Cell Population Data from Sysmex XN-1000 in Early Detection of Acute Leukemia

Ain Shams Medical Journal

Background: Among the more complex tests for the diagnostic workup of acute leukemia (AL), automa... more Background: Among the more complex tests for the diagnostic workup of acute leukemia (AL), automated hematology cell counters provide leucocyte cell population data (CPD) parameters along with the basic complete blood count (CBC) that have the ability to recognize morphological changes in these cells. Aim of the work: Assessment of the efficiency of CPD research parameters obtained by Sysmex XN-1000 auto-analyzer to predict the diagnosis of AL and its subclassification into acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Patients and methods: Cell population data (CPD) parameters from 103 newly diagnosed AL samples were processed on Sysmex XN-1000 auto-analyzer and compared with 101 age-matched controls (51 healthy and 50 reactive subjects). Results: We found significant differences in many CPD neutrophilic, monocytic, and lymphocytic population together with parameters between AL patients and both healthy and reactive controls, particularly those related to the width of dispersion of the parameters related to neutrophil side scatter intensity, neutrophil forward scatter intensity, lymphocyte side scatter intensity, monocyte side scatter intensity and monocyte side fluorescence intensity. To differentiate AML from ALL, the most significant differences were found in the median values of monocyte side scatter and monocyte side fluorescence along with the neutrophil forward scatter area distribution width and neutrophil forward scatter. Conclusion: The CPD parameters generated from Sysmex XN-1000 auto-analyzer during CBC analysis could be a useful tool for the prediction of AL and its lineage.

Research paper thumbnail of Insight into antiphospholipid syndrome: the role and clinical utility of neutrophils extracellular traps formation

Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive c... more Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive complications and pregnancy loss in the absence of definite etiology. Most research focuses on the laboratory detection and clinical features of APLS, but its precise etiology remains to be deeply explored. NETosis is a newly developed theory in the pathophysiology of APLS which may serve as the missing bridge between coagulation and inflammation reaching the disease progression and severity. We aimed in this study to navigate the prognostic role of NETosis in thrombotic APLS. Our study included 49 newly diagnosed APLS patients (both 1ry and 2ry) who met clinical and laboratory criteria as per the international consensus statement on the update of the classification criteria for definite APLS and were sub-classified according to the occurrence of thrombotic events in thrombotic and non-thrombotic types. In addition, 20 sex and age-matched reactive subjects and 20 sex and age-matched healthy volunteer controls were enrolled. NETosis formation was assessed by measuring serum Myeloperoxidase (MPO) and Histones level using the enzyme-linked immunosorbent assay (ELISA) technique. Both MPO and Histones levels were able to discriminate among APLS cases from normal controls, showing significant cutoffs of > 2.09 ng/ml for MPO and > 1.45 ng/ml for Histones (AUC values were 0.987and 1.000, respectively). These values can be used as predictors for NETosis pathophysiology in APLS patients. Additionally, these markers demonstrated a significant association with several prognostic indicators, including thrombosis, higher PT and INR, and lower hemoglobin (Hb) levels which are supposed to be ameliorated by using NETs inhibitors. In conclusion, we suggest that measuring NETosis markers, MPO, and Histones, in the early course of APLS using proposed cutoff values will facilitate the timely initiation of anti-NETosis therapy and improve the overall prognosis, particularly for patients with thrombotic APLS.

Research paper thumbnail of Insight into antiphospholipid syndrome: the role and clinical utility of neutrophils extracellular traps formation

Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive c... more Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive complications and pregnancy loss in the absence of definite etiology. Most research focuses on the laboratory detection and clinical features of APLS, but its precise etiology remains to be deeply explored. NETosis is a newly developed theory in the pathophysiology of APLS which may serve as the missing bridge between coagulation and inflammation reaching the disease progression and severity. We aimed in this study to navigate the prognostic role of NETosis in thrombotic APLS. Our study included 49 newly diagnosed APLS patients (both 1ry and 2ry) who met clinical and laboratory criteria as per the international consensus statement on the update of the classification criteria for definite APLS and were sub-classified according to the occurrence of thrombotic events in thrombotic and non-thrombotic types. In addition, 20 sex and age-matched reactive subjects and 20 sex and age-matched healthy volunteer controls were enrolled. NETosis formation was assessed by measuring serum Myeloperoxidase (MPO) and Histones level using the enzyme-linked immunosorbent assay (ELISA) technique. Both MPO and Histones levels were able to discriminate among APLS cases from normal controls, showing significant cutoffs of > 2.09 ng/ml for MPO and > 1.45 ng/ml for Histones (AUC values were 0.987and 1.000, respectively). These values can be used as predictors for NETosis pathophysiology in APLS patients. Additionally, these markers demonstrated a significant association with several prognostic indicators, including thrombosis, higher PT and INR, and lower hemoglobin (Hb) levels which are supposed to be ameliorated by using NETs inhibitors. In conclusion, we suggest that measuring NETosis markers, MPO, and Histones, in the early course of APLS using proposed cutoff values will facilitate the timely initiation of anti-NETosis therapy and improve the overall prognosis, particularly for patients with thrombotic APLS.

Research paper thumbnail of VALUE OF LEUCOCYTE CELL POPULATION DATA FROM SYSMEX XN-1000 IN EARLY DETECTION OF ACUTE LEUKEMIA

Background: Among the more complex tests for the diagnostic workup of acute leukemia (AL), automa... more Background: Among the more complex tests for the diagnostic workup of acute leukemia (AL), automated hematology cell counters provide leucocyte cell population data (CPD) parameters along with the basic complete blood count (CBC) that have the ability to recognize morphological changes in these cells. Aim of the work: Assessment of the efficiency of CPD research parameters obtained by Sysmex XN-1000 auto-analyzer to predict the diagnosis of AL and its subclassification into acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Patients and methods: Cell population data (CPD) parameters from 103 newly diagnosed AL samples were processed on Sysmex XN-1000 auto-analyzer and compared with 101 age-matched controls (51 healthy and 50 reactive subjects). Results: We found significant differences in many CPD neutrophilic, monocytic, and lymphocytic population together with parameters between AL patients and both healthy and reactive controls, particularly those related to the width of dispersion of the parameters related to neutrophil side scatter intensity, neutrophil forward scatter intensity, lymphocyte side scatter intensity, monocyte side scatter intensity and monocyte side fluorescence intensity. To differentiate AML from ALL, the most significant differences were found in the median values of monocyte side scatter and monocyte side fluorescence along with the neutrophil forward scatter area distribution width and neutrophil forward scatter. Conclusion: The CPD parameters generated from Sysmex XN-1000 auto-analyzer during CBC analysis could be a useful tool for the prediction of AL and its lineage.

Research paper thumbnail of Erythroferrone, the new iron regulator: evaluation of its levels in Egyptian patients with beta thalassemia

Erythroferrone, the new iron regulator: evaluation of its levels in Egyptian patients with beta thalassemia, 2020

Since iron overload is the commonest cause of morbidity and mortality in β thalassemia major (β-T... more Since iron overload is the commonest cause of morbidity and mortality in β thalassemia major (β-TM), it represents one major target in therapeutic management of the disease. The recently discovered erythroid regulator, erythroferrone (ERFE), governed by high levels of erythropoietin, was found to suppress hepcidin expression, thus increasing iron availability for developing erythroid progenitors. We aimed to investigate ERFE levels in Egyptian β-TM patients as an attempt to understand its role in the prediction of iron overload states. Our study included 70 β-TM patients, divided into two subgroups according to the degree of iron overload, and 30 sex and age-matched healthy subjects. ERFE gene expression was analyzed by quantitative real-time polymerase chain reaction (qRT-PCR), and serum hepcidin was measured using enzyme-linked immunosorbent assay (ELISA) technique. Both ERFE gene expression levels and transferrin saturation (TS%) values were able to discriminate among cases with different degrees of iron overload, in contrast to hepcidin. TS% was acknowledged as the best predictor of iron overload (AUC 0.893) in comparison with serum hepcidin and ERFE gene levels (AUC 0.807 and 0.677, respectively), and ERFE gene expression was an independent predictor for the estimated TS%. In conclusion, we suggest that using the ERFE gene expression, combined with serum hepcidin estimation, can substantiate the role of estimated TS% as a promising tool in screening for iron overload in β-TM patients.

Research paper thumbnail of Unpredicted transformation of acute myeloid leukemia with translocation (16;16) (p13; q22): a case report and review of the literature

Unpredicted transformation of acute myeloid leukemia with translocation (16;16) (p13; q22): a case report and review of the literature, 2024

Introduction The transformation of acute myeloid leukemia with translocation (16;16) (p13; q22) f... more Introduction The transformation of acute myeloid leukemia with translocation (16;16) (p13; q22) from AML M2 to acute monocytic leukemia (AML M5) during therapy is a rare clinical occurrence, and this is the first time it has been reported. Clinical complain A 19-year-old male patient was admitted for severe fatigue with anemic manifestation and weight loss, for more than 1 month, with exacerbation of the condition in the last 2 days. Diagnosis A primary diagnosis was made for AML M2 with t (16;16) (p13; q22) established on bone marrow (BM) morphology. A consequential detection of FLT-3 ITD mutation was done. At day 28 follow-up after induction and maintenance therapy, the diagnosis of AML M2 was maintained with a high bone marrow (BM) blast count, prompting the initiation of a more aggressive treatment protocol. After 1 month of implementing the recent protocol, the patient remains morphologically resistant with a notable transformation of bone marrow infiltration by an abnormal monocytic population (monoblasts and promonocytes). The final diagnosis of transforming FLT3-mutated AML with t (16;16) (p13; q22) was established. Intervention After the initial diagnosis of AML M2 with t (16;16) (p13; q22), the patient received the 3 + 7 induction protocol. The 2nd induction protocol initiated after the second evaluation and morphological resistance was the FLAG Adrian protocol. The 3rd protocol after transformation to AML M5 was 1 cycle of the MEC protocol. Anti-FLT3 treatment was considered. Outcomes The patient was maintained on the 3rd protocol of chemotherapy. Unfortunately, he was admitted to the ICU unit complaining of neutropenic fever and severe sepsis where he died before final re-evaluation and the anti-FLT3 treatment initiation. Conclusion AML with t (16;16) (p13; q22) characterized by favorable outcome. However, identifying additional chromosome abnormality or genetic aberration, especially FLT3 gene mutation, is recognized as an important factor influencing final disease outcome. Therefore, early detection of FLT3 mutations will allow comprehensive disease course prediction and targeted therapy that might achieve longer and more durable remissions.