#Acute Myeloid Leukemia (AML)

[ijcimr]

An ‘Uncommon early lineage switch’ in an MLL rearranged adult B-lineage Acute Lymphoblastic Leukemia to Mixed-phenotypic acute leukemia (B/Myeloid) by  Narendra Agrawal in International Journal of Clinical Images and Medical Reviews 

Case Report

Lineage switch is an infrequent phenomenon with an incidence of ~ 0.6% of all de novo leukemias and seen in almost 6% of relapsed cases. This phenomenon is observed following therapy or at the time of relapse. Switch in lineage tends to occur in younger patients and is associated with particularly poor outcomes.[1]

https://ijcimr.org/wp-content/uploads/2022/01/Fig-1__1_.jpg

Discussion

Our clinical report illustrates an adult refractory B -ALL with t (4;11) (q21;23), AF4:MLL fusion who transformed to Mixed-phenotypic acute leukemia;KMT2A-rearranged during his second month of therapy. Lineage switch in MLL rearranged paediatric ALL is common, but in adults it is not well reported. During the literature review, we found 2 cases of adult ALL harbouring t (4;11) transformed to AML [1,4]. First case illustrated chemotherapy responsive MLL rearranged B-ALL who underwent allogeneic stem cell transplantation (Allo SCT) in remission after induction therapy, who transformed to AML post 100 days of Allo SCT[4]. Second case illustrated refractory MLL rearranged B-ALL adult that rapidly transformed to AML following initiation of blinatumomab therapy [1].  However there was no case found to have switched from B acute lymphoblastic leukemia to Mixed-phenotypic acute leukemia;KMT2A-rearranged .Mechanism for lineage switch in MLL rearranged acute leukemia is not clear yet. Reports showing a strong trend of lineage switch involving B and myeloid lineages suggest that B myeloid progenitor might be involved in the mechanism of lineage switch. Studies reporting lineage switch post anti CD19 therapy; blinatumomab and CD19 chimeric antigen receptor (CAR-T), further advocates this theory [3].In our case it is not possible to state that transformation occurred post Venetoclax therapy, as flow cytometric evaluation was not done prior to start of venetoclax therapy. Development of secondary AML as a result of therapy related process can be ruled out in view of early lineage switch (< 6 months of therapy) and consistent finding of the t (4;11) (q21;23) at diagnosis of B-ALL and transformation. The (4;11) rearrangement detected at diagnosis, and phenotypic switch suggests that the original clone harboured a bi-lineage potential. If further genetic studies including NGS or gene expression studies done at baseline could have predicted the bi lineage potential is also unclear as the case reported by Haddox C et al did not show any change in the baseline NGS and the NGS performed during relapse.In conclusion, haematologists should be cognizant while treating MLL rearranged B -ALL adults for a lineage switch. It also underlies the importance of repeat evaluation of the disease if there is no response to standard therapy.

Declarations

Funding Funding information is not applicable to this study.Conflict of Interest All authors declare no conflict of interest to declare.Compliance with Ethical Standards Ethical Approval Statement: All authors stated that the study has been approved by the appropriate institutional review board and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.Acknowledgement We are thankful to our RGCI & RC staff of department of Hematology for their constant supportFor more details: https://ijcimr.org/editorial-board/

#Lineage switch #phenomenon #ALL #Mixed leukemia lineage #acute lymphoblastic leukemia #AML #MLL #acute myeloid leukemia #CD #chemotherapy #dysfunction syndrome #Ara-C #Narendra Agrawal

[jcrmhscasereports]

ACUTE MYELOID LEUKEMIA IN PREGNANCY: DIFFICULT JOURNEY FROM DIAGNOSIS TO DELIVERY AND TREATMENT by Vina Kumari in Journal of Clinical Case Reports Medical Images and Health Sciences 

ABSTRACT

The incidence of Acute Myeloid Leukemia in pregnancy is about 1 in 75,000 to 1 in 100,000. Owing to the therapy attributable risks to mother and fetus, the management of AML in pregnancy is very challenging, both for the parents and the medical fraternity. Furthermore, the diagnosis of leukemia in pregnancy is very difficult owing to vague presenting symptoms like fatigue and weakness which are confused with physiological changes during pregnancy.

Case Report: Primigravida, 33 weeks 6 days gestation age, with history of weakness and fatigue for 15 days and fever, cough and cold for 3 days was referred to our hospital with blood reports of raised total leucocyte count. The lab reports showed thrombocytopenia, anemia and leukocytosis with increased circulating blasts in the peripheral smear. As she was in her third trimester, plan of induction of labor and delivery followed by chemotherapy was taken. She delivered a live healthy baby. Post-delivery, she was advised chemotherapy. She had an immediate remission after the chemotherapy. The disease relapsed after 10 months and she succumbed to the disease due to unavailability of facilities during the COVID pandemic.

Conclusion: AML during pregnancy is rare. There is no fixed protocol for management of AML during pregnancy .The aim of management should be to take care of the initial concerns regarding fetal well-being according to gestation age and commence chemotherapy as soon as possible. This would give the best survival chances to the mother.

Keywords: Acute myeloid leukemia, pregnancy, chemotherapy.

INTRODUCTION

The association of leukemia and pregnancy is very rare, rather under-diagnosed and sparsely reported. The prevalence based on diagnosed and reported cases is one in 75,000 to 100,000 pregnancies. Most of the leukemias diagnosed in pregnancy are myeloblastic.

Acute myeloid leukemia (AML) is characterized by excessive proliferation of blast cells of myeloid lineage. This results in hematopoietic insufficiency like anemia and thrombocytopenia. The symptoms are related to complications of the pancytopenia, such as infections or hemorrhagic diathesis. The mentioned initial symptoms of leukemia in pregnancy are easily attributed to physiological changes related to the pregnancy and hence are either missed or diagnosed late. We report a case of Acute Myeloid Leukemia in a pregnant patient, its management and outcome.

CASE PRESENTATION

18-year-old primigravida presented at 33 weeks 6 days gestation. She was referred with history of weakness since 15 days and fever, cough, cold since 3 days associated with raised leucocyte count. She belonged to low socioeconomic status, was unbooked and had two antenatal visits during her pregnancy. She visited the facility when she had symptoms of gross weakness.

Her first trimester was uneventful. She was registered at a local hospital but was not compliant. Dating scan, trisomy screening and anomaly scan was not done.

On examination, her pulse rate was 88, blood pressure 100/60, respiratory rate 20 per minute, and temperature 99 degree Fahrenheit. She was pale but there was no jaundice, icterus or edema. She had angular stomatitis, and glossitis indicating malnutrition. Lymph nodes were not palpable.

On per abdomen examination, Uterus was relaxed, 33-34 weeks size and fetal heart 143/min. Ultrasound showed a single live fetus in cephalic presentation with effective fetal weight of 2.4 kg and liquor 12.7cm. Placenta was in upper posterior position. The fetus had overdistended urinary bladder with hydronephrosis of fetal kidneys suggestive of bladder outlet obstruction. Moderate hepatosplenomegaly was present. She was moderately anemic with hemoglobin of 8.3 gm/dl. The leucocyte count was very high 2,66,000/cu mm with neutrophils 4, lymphocytes 1, eosinophils 1 and basophils 1. The blood picture showed marked leucocytosis with blasts cells predominating 86% and 2 myelocytes and 1 metamyelocyte. The blast cells typically showed large nuclei, opened up chromatin, prominent nucleoli and cytoplasmic blebs. This picture raised the suspicion of Acute Myeloid Leukemia in pregnancy. Her platelet count was 96000/cu mm. LDH was raised 995 U/L signifying cell lysis. Liver enzymes were also borderline raised. Dengue serology was found negative. Her blood group was O negative. Serum Creatinine - 1.05 mg/dl and Serum uric acid - 10.9 mg/dl were also raised. The blood picture thus indicated towards normochromic normocytic anemia, thrombocytopenia and leukocytosis. On further examination of the peripheral blood smear, a leukoerythroblastic formula was noted with the presence of predominant blast population (86%) (Figure 1).

Peripheral smear showed mostly Monoblasts (red arrow), promonocytes (green arrow) and few myeloblasts (blue arrow) under the oil immersion object 100 X, Leishman stain.

Monoblasts are large cells with abundant cytoplasm, moderately to intensely basophilic, scattered fine azurophilic granules, round nuclei with lacy chromatin and one or more large nucleoli.

Promonocytes have moderate cytoplasm, less basophilic, granulated with occasional large azurophilic granules. Vacuoles are more irregular. Nuclei are delicately folded.

Myeloblasts have large nuclei, fine chromatin, 3-4 prominent nucleoli and few Auer rods in the cytoplasm.

In view of suspected Acute Myeloid Leukemia, she was advised Bone marrow aspiration, biopsy and immunophenotyping, flow cytometry and translocation (15:17) study by oncologist.

The obstetrical examination was normal. All cardiotocographies were reactive. She was started on IV antibiotics, Inj Ceftriaxone 1 gm IV BD and steroids, Inj Betamethasone was given for fetal lung maturity. In view of malignancy with pregnancy, the case was discussed in tumor board on 10/9/19 and a decision for delivery followed by chemotherapy was taken.

She was induced with one dose of intracervical dinoprostone gel following which she went into labour and delivered live baby 2.8 kg weight with good apgar. The baby was shifted to nursery in view of premature delivery and mother was planned to transfer to medical oncology department for Induction chemotherapy.

Repeat investigations three days after delivery, haemoglobin decreased to 7 g/dl, TLC increased to 3,81,000 cells per cu mm with neutrophils 2, lymphocytes 5 and myelocytes 5. The abnormal blast cells had increased to 88% and platelets decreased to 21000 per cu mm (TABLE 1). Serum creatinine also increased to 1.43 mg/dl and e-GFR decreased to 54 ml/min/1.73 m2, indicating compromised renal function. The peripheral picture showed mostly agranuloblasts with moderate to scanty grey blue vacuolated cytoplasmic nuclei showing convolutions and 1-3 nucleoli occasional myelocytes, metamyelocytes seen, findings in favour of Acute myeloid leukemia (M4/M5). On myeloperoxidase staining, only 40 % took up the stain indicating AML-M4 lineage. She was transfused with one packed cell and one single donor platelet, following which her condition improved. She was transferred to medical oncology ward where she received chemotherapy and had immediate remission of the disease.

Table 1: Sequential Investigation Reports during hospital stay

DISCUSSION

The Incidence of Acute Myeloid Leukemia is 1 in 75,000 to 100,000 pregnancies with maximum 40% presenting in third trimester and 23% and 37% in first and second trimester respectively. In a population based study by Nolan et al [1], out of total acute leukaemia cases, two thirds are myeloblastic and one third lymphoblastic leukemia.

The rarity of disease during pregnancy, might also be due to very low reporting in view of confusing diagnosis. The symptoms of AML can easily be confused with symptoms of anaemia like malaise, easy fatigueability, low grade fever. Thrombocytopenia and anaemia are relatively common findings in pregnancy. Although, Neutropenia is rare and merits further investigation or close monitoring. But in the developing country like India, it is majorly missed. Thus, whenever there is presence of circulating blasts in a blood film, it suggests a diagnosis of haematological malignancy and is an indication for bone marrow biopsy. The other differential diagnosis that should be kept in mind are Thrombotic microangiopathy, HELLP syndrome and Cytopenias of deficiency or immune origin [2].

The tests to be done before bone marrow aspiration are Full blood count, blood film examination, Vitamin B12, folate and ferritin measurement, Coagulation screen, Renal and liver function tests. All these were done for our patient and further bone marrow aspiration was suggested with studies directed at Immunophenotypic, cytogenetic and molecular analysis for accurate subtyping and understanding of prognostic features.

Once diagnosed, a Multidisciplinary approach comprising of hematologists, obstetricians, anesthetists and neonatologists is the key to appropriate management. Consideration should be given to health of both mother and baby. The woman should be fully informed about the diagnosis, treatment of the disease and possible complications during pregnancy , clearly implying that any treatment delays might result in compromised maternal outcome without improving the outcome for the fetus [3].

The risks of Leukemia, disease per se, to pregnancy is miscarriage, foetal growth restriction, perinatal mortality, premature labour and Intrauterine fetal death [4].

Due to the high risk of the disease, there are different recommendations for management of AML in pregnancy in the three trimesters owing to the urgent need of chemotherapeutic agents and the adverse effects of the drugs involved .

If it is diagnosed in the first trimester, the patient should be counselled for elective abortion, medical/surgical and starting of chemotherapy. Between 13- 24 weeks, the Induction chemotherapy should be started while pregnancy is continued [5]. Preterm termination of pregnancy is indicated after fetal viability. Similar conclusions were derived by Nicola et al and Farhadfar in a single centre study of 5 and 23 case of AML diagnosed during pregnancy respectively [6,7].

Between 24 - 32 weeks, chemotherapy exposure to the fetus must be balanced against risks of prematurity following elective delivery at that stage of gestation (Grade 1C). At gestation age more than 32 weeks, the fetus should be delivered prior to Induction chemotherapy.

Chemotherapy with anthracycline based regimens are favored. According to a meta-analysis done by Natanel A Horowitz et al, anthracycline based regimens were associated with maximum remission but overall maternal survival was very low (30%)[8]. Even in our case, although the mother immediately had remission with chemotherapy. There was a recurrence after disease free 10 months and she succumbed to the disease during the COVID pandemic. Quinolones, tetracyclines and sulphonamides are better avoided in pregnancy(Grade 1B).

In one case report by Abdullah et al, a trial of 5- azacytidine has shown promising results [9]. The antifungal of choice in pregnancy is Amphotericin B or lipid derivatives (Grade 2C). If blood transfusion is needed, the blood should be screened for Cytomegalovirus (Grade 1B). Supportive therapy like a course of Corticosteroids given if delivery is between 24 and 35 weeks gestation (Grade 1A) [10]. Magnesium sulphate should be considered 24 h prior to delivery before 30 weeks gestation (Grade 1A).

Delivery should be planned for a time when the woman is at least 3 weeks post-chemotherapy to minimize risk of neonatal myelosuppresion (Grade 1C). Planned delivery is preferred, like Induction of labour (Grade 2C). Caesarean section is indicated only for obstetric indications. Epidural analgesia is better avoided.

The Dose of chemotherapy is calculated on their actual body weight with dose adjustments for weight gain during pregnancy owing to various pregnancy changes.

The Chemotherapy agents have a MW of 250-400 KDa and hence can cross the placenta resulting in detrimental teratogenic effects on developing fetus.Sunny J. Patel et al have done a comprehensive analysis on outcomes in hospitalized pregnant patients with acute myeloid leukemia and come to conclusion that a multidesciplinary, holistic approach leads to quick remission of the disease [11]

After delivery, histopathologic examination of placenta to rule out placental transfer to fetus is advisable. Cytologic examination should be performed in both maternal and umbilical cord blood and neonates should be clinically examined for palpable skin lesions, organomegaly or other masses. If the baby is found to be healthy, a follow up after every six months for two years is recommended. In each visit, physical examination, chest x-ray and liver function tests should be done.

CONCLUSION

Acute myeloid leukemia in pregnancy is a Rare diagnosis and even rarely reported. With the trend for delaying pregnancy into the later reproductive years, we expect to see more cases of cancer complicating pregnancy. Presently, there are no clear management guidelines to address timing and dosing of anthracycline/cytarabine based regimens especially in pregnancy. The potential drug toxicity to mother and fetus and transplant considerations in intermediate and highrisk patients during pregnancy has not been addressed.

What we also need today is a National registry for leukemia patients, treated in pregnancy. This will help us to answer many unanswered queries and improve maternal and fetal overall survival rates. Although we have few comprehensive studies, but further studies and references are needed. Finally, a Multidisciplinary team is needed to provide comprehensive care to patients.

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

#Acute myeloid leukemia #pregnancy #chemotherapy #AML #cytoplasm #leukoerythroblastic #hematologists #obstetricians #anesthetists #Vina Kumari #jcrmhs

[joseywritesng]

An aggressive leukemia is more deadly for black patients

An aggressive leukemia is more deadly for black patients

By Cara Murez HealthDay ReporterHealthDay Reporter THURSDAY, July 7, 2022 (HealthDay News) — Getting a blood cancer diagnosis is devastating for young people, but it’s also much more deadly if the patient is black, new research shows. The new study, which looked at outcomes for patients with acute myeloid leukemia (AML), highlights the urgent need to understand racial and ethnic differences, as…

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#aml #black patients #Leukemia #white patients #with acute myeloid leukemia

[guilt-na-zan]

hiii!!! i lurk around a lot of communities but im making a post to share something important! (plz reblog!)

earlier this year my dad was diagnosed with acute myeloid leukemia, aka, a type of cancer that has been aggressive. right now, he has lost the ability to generate income so it's been hard to pay for expenses. our family is working with him on stuff but yk it's still really demanding. any help is appreciated, whether is a reblog, repost on a different site or donating, it's all appreciated 💗 i'll be tagging some communities im in so i'm sorry if this is out of place !!

(dropping some gifs just so it's not ENTIRELY outta place)

#gfm #gofundme #cancer #leukemia #tw illness #ib #writing community #lgbtq community #lgbtq #ocs #oc artist #mha #bnha

[eugeniogalindo]

Staging of Leukemia

Unlike most solid tumors, leukemia is not classified by stage based on tumor size or spread. Different staging systems exist for each leukemia subtype. Overall, leukemia staging consists of multiple criteria including the type, count, and degree of maturation of specific blood cells, as well as the presence of enlarged lymph nodes.

Acute lymphoblastic leukemia (ALL) staging is based on the type and maturity of affected blood cells. The two main types of ALL are B-cell and T-cell ALL. Each type is staged according to the maturity of the blood cells. For example, B-cell ALL is classified as early pre-B, pre-B, common, or mature B-cell. T-cell ALL is classified as pre-T or mature T-cell.

There are two staging systems for acute myeloid leukemia (AML). The French-American-British (FAB) system consists of eight stages based on blood cell type and maturity. Stages M0 to M5 refer to cancers that develop from immature white blood cells like myeloblasts and promyelocytes. Stage M6 refers to acute erythroid leukemia, where malignancy originates from immature red blood cells, whereas stage M7 develops from megakaryoblasts, or platelet-forming cells. Alternatively, the World Health Organization (WHO) stages AML based on prognostic factors such as genetic abnormalities, comorbidities, and cellular differentiation.

Doctors can stage chronic lymphocytic leukemia (CLL) using the Rai or the Binet system. The Rai system is used in the United States. Comprising five stages, it assesses the severity of CLL based on three criteria: lymphocyte count, enlargement of lymph nodes, liver, or spleen, and development of blood disorders like anemia or thrombocytopenia. Rai stage 0, or low-risk CLL, is characterized by high lymphocyte count only, whereas stage 1 also includes enlarged lymph nodes. The liver or spleen may become enlarged in stage 2. Anemia and thrombocytopenia may develop in stages 3 and 4, or high-risk CLL.

In Europe, the Binet staging system focuses on enlargement of lymphoid tissue. Stage A describes CLL cases where some lymph nodes are swollen, stage B includes swollen lymphoid tissues in more than three areas, and stage C - like high-risk CLL in the Rai system - features anemia or thrombocytopenia.

The staging system for chronic myeloid leukemia (CML) is composed of phases that describe the number of immature white blood cells, also known as blasts, found in the bone marrow and bloodstream. Chronic CML is the earliest stage, where blasts account for less than 10 percent of total blood cells and patients present mild symptoms. In accelerated CML, blast growth progresses rapidly and results in more severe symptoms, such as weight loss. The most aggressive stage of CML is the blast phase, where blasts account for at least 20 percent of all blood cells and patients exhibit symptoms as severe as those with AML.

Doctors conduct various tests to accurately stage leukemia. They use diagnostic methods such as blood tests, bone marrow biopsy, and imaging modalities. A complete blood count, or CBC, determines the number of different cells in the bloodstream, and plays an important role in evaluating the severity of leukemia. Similarly, a bone marrow biopsy, taken from the patient’s hip bone, allows doctors to detect and identify the type of leukemia cells present in the bone marrow. Imaging modalities like x-rays and positron emission tomography (PET) scans can locate leukemia metastases in other parts of the body.

#Eugenio Galindo

[urfriendlyneighbornightfury]

PLEASE DON'T IGNORE ME!

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML).

She's been on chemo for weeks. But we need to raise money against her bone marrow transplant, The good thing is we found a match early, the bad thing is We currently are not financially capable to pay for it. Nini's condition is not so good  and we hope she gets better  and that's why I'm pleading for your support towards Nini's treatment. We'd appreciate your donation if you can, i've chosen a platform which accepts as low as $1, this shows how urgent and desperate we her to continue her treatments. On my pinned post is her story, latest update on her treatment and link to donate. Kindly spare some bucks if you can. I'd also appreciate your reblog to reach larger audience. If you're LGBTQ+ please tag any fellow LGBTQ person/community, who you think might help one of their own. Sorry if you're not, I strongly believe in the love and support from the community and everyone at large. Dont forget to signal boost please, don't air me please.

Thank you.

Hello! Apologies for the late response, I had a few family issues to resolve first, but I will boost this as best I can.

While I cannot donate (I have no means to do so, nor the money) I can attempt to help in any way I can.

As a person who had gone through a Bone Marrow Transplant themselves and survived (though mine was an autoimmune blood disease, Aplastic Anemia, which is a "cousin" to Leukemia), I can be someone to talk to, should the need arise. (I should note that I live in Germany, within the Paris timezone, so that the time difference can be taken into account) I also recommend the website Caring Bridge. My mom used it to post updates about my health and well being when I got my transplant eleven years ago, so that family and friends could know how I was doing, not just in the States (while I lived there. Most of my family is in Germany). So you can keep your loved ones up to date with Nini's health (or she can, if she has the energy to). Plus, you can connect with other patients undergoing the same thing.

Tagging as many people as possible (mutuals, followers, even those I follow): @shadows-fan-space @caddy-crystal-queen @just-some-girl-92 @a-dorin @blackkatmagic @emperor-palpaminty @exceptionally-minded @general-kalani @happytroopers @halzore @haloangel391 @igotanaddixon @icaruspendragon @kingoffantasy516 @lilhawkeye3 @a-lil-perspective @nahoney22 @neon-junkie @ollovaemisc @rowansparrow @starryfictionalgirl @vinciwolf @voidika @wille-zarr @superiorsniper @tbbs-best-hair @zinzinina @fandom-blackhole @lula-and-the-cavalry @the-echo-in-the-room @zoeykallus @moonstrider9904 @its-capt-traitor-to-you @same-heart-same-blood @badbatchsmolbean @tech-deck @tchatso @tinywitchgoblin @ohhhbuthoney @dragon-pups @anstarwar @agent-catfish-kenobi @drabbles-n-doodles @historicallydysfunctional @comm-caribou @pandalover19 @monako-jinn-stories @dexara

If any of you can donate or spread the word, please do. This one in particular sits close to me as a former BMT patient. I wish you all the best, Esther, and hope Nini makes a swift recovery, and that she stays healthy! Strong hopes for no GvHD!

#bone marrow transplant #lgbtq+ #lets help these two lovelies #queer community #spreading the word #signal boost

[sspiderj]

PLEASE DON'T IGNORE ME!

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML).

She's been on chemo for weeks. But we need to raise money against her bone marrow transplant, The good thing is we found a match early, the bad thing is We currently are not financially capable to pay for it. Nini's condition is not so good  and we hope she gets better  and that's why I'm pleading for your support towards Nini's treatment. We'd appreciate your donation if you can, i've chosen a platform which accepts as low as $1, this shows how urgent and desperate we her to continue her treatments. On my pinned post is her story, latest update on her treatment and link to donate. Kindly spare some bucks if you can. I'd also appreciate your reblog to reach larger audience. If you're LGBTQ+ please tag any fellow LGBTQ person/community, who you think might help one of their own. Sorry if you're not, I strongly believe in the love and support from the community and everyone at large. Dont forget to signal boost please, don't air me please.

Thank you.

thank you so much for sharing, I wish your girlfriend the best of luck. unfortunately I can’t donate, but I’ll do my best to share this around

#boost this #asks #froggy answers

[plushav]

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML).

She's been on chemo for weeks. But we need to raise money against her bone marrow transplant, The good thing is we found a match early, the bad thing is We currently are not financially capable to pay for it. Nini's condition is not so good  and we hope she gets better  and that's why I'm pleading for your support towards Nini's treatment. We'd appreciate your donation if you can, i've chosen a platform which accepts as low as $1, this shows how urgent and desperate we her to continue her treatments. On my pinned post is her story, latest update on her treatment and link to donate. Kindly spare some bucks if you can. I'd also appreciate your reblog to reach larger audience. If you're LGBTQ+ please tag any fellow LGBTQ person/community, who you think might help one of their own. Sorry if you're not, I strongly believe in the love and support from the community and everyone at large.

Thank you.

this is definitely not a bot sending asks from a terminated account. i searched the handle in description and the fundraising site you chose to handle your payments doesn't even use https

#scam #zap!

[alwayssometimesakira]

PLEASE READ!!

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML).She's been on chemo for weeks. But we need to raise money for her bone marrow transplant, we found a match early and due to her quick response to treatment shes due for transplant in few week. We stopped seeking public hepp last or two months ago because we thought we are now financially good but after some maths we got to know we still need $1,500, we adjusted the goal and reopend the campaign, ever since we havent gotten a support/donation, her transplant is due in less than 3weeks. On my pinned post is her story, latest update on her treatment and link to donate. Kindly spare some bucks if you can, as, we are desperately in need of a minimum of $1,500 bucks on or before next month. I'd also appreciate your reblog to reach larger audience. If you have come across this post before please do reblog my post again. don't ignore me please.

Sorry for the inconvenience and Thank you for your time

I would typically delete something like this since it looks like a scam. You have no profile image, no background, and your reblogs look bot-randomized. Your *spotfund is no better. No pictures, no profile image, and I'm sorry to say this but stories like this are dime a dozen with scams. If you're real ACT LIKE IT!

Guess we have more scams to worry about now.

#yeah I don't have money anyway #I have my own knee surgeries to worry about #likely scam #scam

[solis-angelus]

PLEASE DON'T IGNORE ME!

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML).

She's been on chemo for weeks. But we need to raise money against her bone marrow transplant, The good thing is we found a match early, the bad thing is We currently are not financially capable to pay for it. Nini's condition is not so good  and we hope she gets better  and that's why I'm pleading for your support towards Nini's treatment. We'd appreciate your donation if you can, i've chosen a platform which accepts as low as $1, this shows how urgent and desperate we her to continue her treatments. On my pinned post is her story, latest update on her treatment and link to donate. Kindly spare some bucks if you can. I'd also appreciate your reblog to reach larger audience. If you're LGBTQ+ please tag any fellow LGBTQ person/community, who you think might help one of their own. Sorry if you're not, I strongly believe in the love and support from the community and everyone at large. Dont forget to signal boost please, don't air me please.

Thank you.

Boosting this bcz i have no money. Hoping she gets well. <3

People please donate if you can.

#boost #signal boost #lgbtq

[sunflowersand-bees]

PLEASE DON'T IGNORE ME!

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML).

She's been on chemo for weeks. But we need to raise money against her bone marrow transplant, The good thing is we found a match early, the bad thing is We currently are not financially capable to pay for it. Nini's condition is not so good  and we hope she gets better  and that's why I'm pleading for your support towards Nini's treatment. We'd appreciate your donation if you can, i've chosen a platform which accepts as low as $1, this shows how urgent and desperate we her to continue her treatments. On my pinned post is her story, latest update on her treatment and link to donate. Kindly spare some bucks if you can. I'd also appreciate your reblog to reach larger audience. If you're LGBTQ+ please tag any fellow LGBTQ person/community, who you think might help one of their own. Sorry if you're not, I strongly believe in the love and support from the community and everyone at large. Dont forget to signal boost please, don't air me please.

Thank you.

I apologize, but I can't donate. I will, however tag some people and see if they can donate.

@beachthem @pan-rainbows-are-me @felinedynamite @the-name-is-loser @baykitthings @virgils-lair @theimprobabledreamersworld @iggyalfi2319

I hope you guys aren't bothered by the tag, and if you can't donate, continue to boost this!

#ask

[pryotra]

Hi everyone, one of my long time readers and a personal friend asked me to share this link to help her mother who was just diagnosed with cancer.

If you have the ability, please help!

#go fund her #not fate #but more important

[inkedberries]

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML). With the help of friends and some LGBTQ community, we have been able to commence treatment for my beloved girlfriend, but things escalated quickly based on the nature of the ailment. We currently are not financially capable to treat it as fast as we should. It's getting worse and that's why I'm pleading for your support towards Nini's treatment. We'd appreciate your donation if you can, i've chosen a platform which accepts as low as $1, this shows how urgent and desperate we her to continue her treatments. On my pinned post and description is the post I made about it. We'd appreciate your reblog to reach larger audience. Please consider rebloging to save my girlfriend. Thank you

here's the post, to anyone who wants to help

#im sorry im not from the US so they cant accept my card #donation post #bean talks

[autistic-ace-bee]

PLEASE DON'T IGNORE ME!

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML).

She's been on chemo for weeks. But we need to raise money against her bone marrow transplant, The good thing is we found a match early, the bad thing is We currently are not financially capable to pay for it. Nini's condition is not so good  and we hope she gets better  and that's why I'm pleading for your support towards Nini's treatment. We'd appreciate your donation if you can, i've chosen a platform which accepts as low as $1, this shows how urgent and desperate we her to continue her treatments. On my pinned post is her story, latest update on her treatment and link to donate. Kindly spare some bucks if you can. I'd also appreciate your reblog to reach larger audience. If you're LGBTQ+ please tag any fellow LGBTQ person/community, who you think might help one of their own. Sorry if you're not, I strongly believe in the love and support from the community and everyone at large. Dont forget to signal boost please, don't air me please.

Thank you.

.

#signal boost #lgbt #caps

[they-are-a-prolife-autist]

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML). With the help of friends and some LGBTQ community, we have been able to commence treatment for my beloved girlfriend, but things escalated quickly based on the nature of the ailment. We currently are not financially capable to treat it as fast as we should. It's getting worse and that's why I'm pleading for your support towards Nini's treatment. We'd appreciate your donation if you can, i've chosen a platform which accepts as low as $1, this shows how urgent and desperate we her to continue her treatments.

Please click here to read more and donate if you can  - spot.fund/SaveMyLeukemiaGirlfriend

You can read the post I made about on my blog.(I have the link on my description/bio).Your support is so more appreciated. Thank you .

.

[the-jelliphish]

PLEASE DON'T IGNORE ME!

Hello. I'm Esther and I'm sending this to you on behalf of my girlfriend(NiNi), who have been diagnosed with Acute Myeloid Leukemia (AML).

She's been on chemo for weeks. But we need to raise money against her bone marrow transplant, The good thing is we found a match early, the bad thing is We currently are not financially capable to pay for it. Nini's condition is not so good  and we hope she gets better  and that's why I'm pleading for your support towards Nini's treatment. We'd appreciate your donation if you can, i've chosen a platform which accepts as low as $1, this shows how urgent and desperate we her to continue her treatments. On my pinned post is her story, latest update on her treatment and link to donate. Kindly spare some bucks if you can. I'd also appreciate your reblog to reach larger audience. If you're LGBTQ+ please tag any fellow LGBTQ person/community, who you think might help one of their own. Sorry if you're not, I strongly believe in the love and support from the community and everyone at large. Dont forget to signal boost please, don't air me please.

Thank you.

I'm so sorry to here that, but i can't donate. But if anyone else can please do!! I sincerely hope you guys can raise the money you need!!!