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Li W, Shi M, Zhou P, Liu Y, Liu X, Xiao X, Zuo S, Bai Y, Sun K. Extramedullary infiltration in pediatric acute myeloid leukemia: Results from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) initiative. Pediatr Blood Cancer 2024; 71:e31014. [PMID: 38644612 DOI: 10.1002/pbc.31014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND The outcome of extramedullary infiltration (EMI) in pediatric acute myeloid leukemia (AML) is controversial, and little is known about the implications of stem cell transplantation (SCT) and gemtuzumab ozogamicin (GO) treatment on patients with EMI. METHODS We retrieved the clinical data of 713 pediatric patients with AML from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) dataset, and analyzed the clinical and prognostic characteristics of patients with EMI at diagnosis and relapse. RESULTS A total of 123 patients were identified to have EMI at diagnosis and 64 presented with EMI at relapse. The presence of EMI was associated with age ≤2 years, M5 morphology, abnormal karyotype, and KMT2A rearrangements. Hyperleukocytosis and complex karyotype were more prevalent in patients with EMI at relapse. Additionally, patients with EMI at diagnosis had a reduced incidence of FLT3 ITD-/NPM1+, whereas those with EMI at relapse displayed a lower frequency of FLT3 ITD+. Patients with EMI at diagnosis exhibited a lower complete remission (CR) rate at the end of Induction Course 1 and higher relapse incidence. Importantly, EMI at diagnosis independently predicted both shorter event-free survival (EFS) and overall survival (OS). Regarding relapse patients, the occurrence of EMI at relapse showed no impact on OS. However, relapse patients with myeloid sarcoma (MS)/no central nervous system (CNS) exhibited poorer OS compared to those with CNS/no MS. Furthermore, regarding patients with EMI at diagnosis, SCT failed to improve the survival, whereas GO treatment potentially enhanced OS. CONCLUSION EMI at diagnosis is an independent adverse prognostic risk factor for pediatric AML, and GO treatment potentially improves survival for patients with EMI at diagnosis.
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Affiliation(s)
- Weiya Li
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Mingyue Shi
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Pan Zhou
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Ying Liu
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Xiaobo Liu
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Xingjun Xiao
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Suqiong Zuo
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Yanliang Bai
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
| | - Kai Sun
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Henan, P. R. China
- Department of Hematology, Beijing JiShuiTan Hospital, Capital Medical University, Beijing, P. R. China
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2
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Kamat A, Opipari V, Habiger C, Jasty R, Mody R, Sedig L. Primary myeloid sarcoma in an infant with an NRAS mutation. Pediatr Blood Cancer 2024; 71:e30946. [PMID: 38462746 DOI: 10.1002/pbc.30946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Aarti Kamat
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Valerie Opipari
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Clayton Habiger
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rama Jasty
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rajen Mody
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Laura Sedig
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
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3
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Qin VL, Verkuil L, Zanganeh T, Wertheim G, Davidson SL. Iris and orbital myeloid sarcoma in a pediatric patient. J AAPOS 2023; 27:157-160. [PMID: 37207926 DOI: 10.1016/j.jaapos.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 05/21/2023]
Abstract
We report the case of a 35-month-old previously healthy girl who presented with a history of several months of both an enlarging orbital mass and a contralateral iris mass as her initial signs of acute myeloid leukemia.
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Affiliation(s)
- Vivian L Qin
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lana Verkuil
- Kaiser Permanente Northern California, Oakland, California
| | - Tatiana Zanganeh
- Department of Ophthalmology, 96th Medical Group, Eglin Air Force Base, Florida
| | - Gerald Wertheim
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stefanie L Davidson
- Division of Pediatric Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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4
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Gallardo MS, Joyrich R, Taub JW. Pediatric acute myeloid leukemia with breast chloromas. EJHAEM 2023; 4:488-490. [PMID: 37206254 PMCID: PMC10188463 DOI: 10.1002/jha2.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Maria S Gallardo
- Division of Pediatric Hematology/Oncology Children's Hospital of Michigan Detroit Michigan USA
| | - Richard Joyrich
- Department of Hematology-Oncology Karmanos Cancer Institute, Wayne State University Detroit Michigan USA
| | - Jeffrey W Taub
- Division of Pediatric Hematology/Oncology Children's Hospital of Michigan Detroit Michigan USA
- Discipline of Pediatrics Central Michigan University College of Medicine Detroit Michigan USA
- Department of Pediatrics Wayne State University School of Medicine Detroit Michigan USA
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5
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Zorn KE, Cunningham AM, Meyer AE, Carlson KS, Rao S. Pediatric Myeloid Sarcoma, More than Just a Chloroma: A Review of Clinical Presentations, Significance, and Biology. Cancers (Basel) 2023; 15:1443. [PMID: 36900239 PMCID: PMC10000481 DOI: 10.3390/cancers15051443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
Myeloid sarcomas (MS), commonly referred to as chloromas, are extramedullary tumors of acute myeloid leukemia (AML) with varying incidence and influence on outcomes. Pediatric MS has both a higher incidence and unique clinical presentation, cytogenetic profile, and set of risk factors compared to adult patients. Optimal treatment remains undefined, yet allogeneic hematopoietic stem cell transplantation (allo-HSCT) and epigenetic reprogramming in children are potential therapies. Importantly, the biology of MS development is poorly understood; however, cell-cell interactions, epigenetic dysregulation, cytokine signaling, and angiogenesis all appear to play key roles. This review describes pediatric-specific MS literature and the current state of knowledge about the biological determinants that drive MS development. While the significance of MS remains controversial, the pediatric experience provides an opportunity to investigate mechanisms of disease development to improve patient outcomes. This brings the hope of better understanding MS as a distinct disease entity deserving directed therapeutic approaches.
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Affiliation(s)
- Kristin E. Zorn
- Department of Pediatrics, Division of Hematology/Oncology/Transplantation, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Versiti Blood Research Institute, Milwaukee, WI 53226, USA
| | | | | | - Karen Sue Carlson
- Versiti Blood Research Institute, Milwaukee, WI 53226, USA
- Department of Medicine, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sridhar Rao
- Department of Pediatrics, Division of Hematology/Oncology/Transplantation, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Versiti Blood Research Institute, Milwaukee, WI 53226, USA
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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6
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Fujikawa T, Kishimoto K, Inoue S, Nishimura A, Tojo R, Uemura S, Nakamura S, Saito A, Kozaki A, Ishida T, Mori T, Higashino M, Koyama J, Kawamura A, Hasegawa D, Kosaka Y. Epidural Spinal Cord Compression as the Presenting Manifestation of Acute Myeloid Leukemia: A Case Report and Literature Review. Intern Med 2023; 62:453-457. [PMID: 35793962 PMCID: PMC9970809 DOI: 10.2169/internalmedicine.9580-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We herein report a rare case of spinal cord compression due to epidural involvement of acute myeloid leukemia (AML). A 14-year-old boy presented with a 7-day history of back pain, paraplegia and hypoesthesia. Contrast-enhanced computed tomography revealed an epidural mass. Emergency laminectomy and resection of the mass were performed. Histopathologically, the resected mass was comparable to an extramedullary mass of AML. Chemotherapy was initiated, and complete remission was achieved. Neurological sequelae remained after the treatment. Based on the present and previous reports, spinal cord compression from epidural AML involvement may progress rapidly.
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Affiliation(s)
- Tomoko Fujikawa
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Kenji Kishimoto
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Shotaro Inoue
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Akihiro Nishimura
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Ryunosuke Tojo
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Suguru Uemura
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Sayaka Nakamura
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Atsuro Saito
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Aiko Kozaki
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Toshiaki Ishida
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | - Takeshi Mori
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
| | | | - Junji Koyama
- Department of Neurosurgery, Kobe Children's Hospital, Japan
| | | | | | - Yoshiyuki Kosaka
- Department of Hematology and Oncology, Kobe Children's Hospital, Japan
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Successful Treatment of Pediatric Acute Myeloid Leukemia Presenting with Hyperbilirubinemia Secondary to Myeloid Sarcoma: A Case Report. CHILDREN 2022; 9:children9111699. [PMID: 36360428 PMCID: PMC9688313 DOI: 10.3390/children9111699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
Myeloid sarcoma (MS), a tumor consisting of myeloid blasts with or without maturation, occurs at anatomical sites other than the bone marrow. MS of the gastrointestinal tract presenting with jaundice in children is rare. We report the case of a 4-year-old boy with a 6-week history of symptoms of obstructive jaundice due to a peripancreatic mass compressing the common bile duct. Six weeks later, blasts were found in a peripheral smear prior to surgical biopsy; bone marrow evaluation and flow cytometry results led to a diagnosis of acute myeloid leukemia (AML) with MS. No further invasive testing or temporary drainage was performed. He was started on induction therapy with full therapeutic doses of cytarabine, dose reductions of etoposide, and escalating doses of daunorubicin. His liver enzymes normalized, and he completed subsequent cycles of chemotherapy with full doses. The abdominal ultrasound showed resolution of the mass after the second cycle of chemotherapy. He is currently in remission three years after completing therapy. AML-directed chemotherapy in patients with obstructive jaundice secondary to MS may be beneficial without requiring invasive testing or temporary drainage procedures. Daily follow-up is crucial for chemotherapy dose modifications. Management plans should be individualized according to the patient’s clinical condition.
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8
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Oya S, Osone S, Yoshida M, Nishimoto S, Taura Y, Yoshida H, Miyachi M, Inaba T, Konishi E, Kato M, Imamura T, Iehara T. Identification of RCC1-LCK as a novel fusion gene in pediatric erythroid sarcoma. Pediatr Blood Cancer 2022; 69:e29848. [PMID: 35714314 DOI: 10.1002/pbc.29848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/06/2022]
Abstract
Erythroid sarcoma is a very rare subtype of myeloid sarcoma with undetermined biological features. Here, we present an infant with a multifocal erythroid sarcoma, diagnosed because the tumor cells were positive for glycophorin A. After acute myeloid leukemia-oriented chemotherapy and surgical resection followed by cord blood transplantation, he has successfully maintained complete remission without any late effects. Total transcriptome analysis of the tumor identified a novel fusion gene, RCC1-LCK, and high LCK expression levels, suggesting that LCK overexpression was involved in leukemogenesis in this case.
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Affiliation(s)
- Satoru Oya
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinya Osone
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masanori Yoshida
- Department of Pediatric Hematology and Oncology Research, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Sota Nishimoto
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihiro Taura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideki Yoshida
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsuru Miyachi
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tohru Inaba
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Motohiro Kato
- Department of Pediatric Hematology and Oncology Research, Research Institute, National Center for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
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9
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Pearls and updates: cutaneous signs of systemic malignancy. Curr Opin Pediatr 2022; 34:367-373. [PMID: 35794009 DOI: 10.1097/mop.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Children with systemic malignancies can present with concomitant dermatological manifestations. Cutaneous findings can occur before, during or after diagnosis. Recognizing these features can aid in diagnosis, inform prognosis, and help determine appropriate treatment. Following a review of the literature published over the past two years, we provide an update on cutaneous signs of pediatric systemic malignancies, concentrating on; leukemia cutis, lymphoma cutis, neuroblastoma, sarcomas, Langerhans cell histiocytosis and paraneoplastic syndromes. RECENT FINDINGS Authors highlight the persistently heterogeneous features of cutaneous manifestations of systemic malignancy. Findings are often nonspecific, and a definitive diagnosis requires skin biopsy with immunophenotyping. Several studies describe dermoscopy features, demonstrating this as a useful tool in clinical evaluation. Genetic mutations underlying the pathogenesis of disease continue to be elucidated. Further, advances in medical treatment led to improved prognosis in many systemic malignancies, with early and aggressive treatment heralding better outcomes. SUMMARY Comprehensive cutaneous evaluation alongside thorough clinical history and review of systems remains of paramount importance as dermatological manifestations of systemic malignancy are notoriously variable with a shared feature of often appearing benign but persisting despite usual treatment. Urgent referral to dermatology is recommended when suspicion for any cutaneous presentation of malignancy arises.
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10
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Samborska M, Barańska M, Wachowiak J, Skalska-Sadowska J, Thambyrajah S, Czogała M, Balwierz W, Kołtan S, Peszyńska-Żelazny K, Wysocki M, Ociepa T, Urasiński T, Wróbel G, Węcławek-Tompol J, Ukielska B, Chybicka A, Kitszel A, Krawczuk-Rybak M, Szmydki-Baran A, Malinowska I, Matysiak M, Mizia-Malarz A, Tomaszewska R, Szczepański T, Chodała-Grzywacz A, Karolczyk G, Maciejka-Kembłowska L, Irga-Jaworska N, Badowska W, Dopierała M, Kurzawa P, Derwich K. Clinical Characteristics and Treatment Outcomes of Myeloid Sarcoma in Children: The Experience of the Polish Pediatric Leukemia and Lymphoma Study Group. Front Oncol 2022; 12:935373. [PMID: 35875115 PMCID: PMC9300998 DOI: 10.3389/fonc.2022.935373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022] Open
Abstract
IntroductionMyeloid sarcoma (MS) is an extramedullary malignant tumor composed of immature myeloid cells. It occurs in patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or chronic myeloid leukemia (CML). MS may coincide with disease diagnosis or precede bone marrow involvement by months or even years; it can also represent the extramedullary manifestation of a relapse (1, 2).AimThe aim of this study is to describe clinical characteristics of children diagnosed with MS in Poland as well as to analyze diagnostic methods, treatment, and outcomes including overall survival (OS), relapse-free survival (RFS), and event-free survival (EFS). The study also attempted to identify factors determining treatment outcomes.PatientsThe study group comprised 43 patients (F=18, M=25) aged 0-18 years (median age, 10.0 years; mean age, 8.8 years) diagnosed with MS based on tumor biopsy and immunohistochemistry or identification of underlying bone marrow disease and extramedullary tumor according to imaging findings.MethodsThe clinical data and diagnostic and therapeutic methods used in the study group were analyzed. A statistical analysis of the treatment outcomes was conducted with STATISTICA v. 13 (StatSoft, Inc., Tulsa, OK, USA) and analysis of survival curves was conducted with MedCalc 11.5.1 (MedCalc Software, Ostend, Belgium). Statistical significance was considered at p<0.05.ResultsIn the study group, MS was most frequently accompanied by AML. The most common site of involvement was skin, followed by orbital region. Skin manifestation of MS was more common in the age group <10 years. The most frequent genetic abnormality was the t(8;21)(q22;q22) translocation. The 5-year OS probability (pOS), 5-year RFS probability (pRFS), and 5-year EFS probability (pEFS) were 0.67 ± 0.08, 0.79 ± 0.07, and 0.65 ± 0.08, respectively. In patients with isolated MS and those with concurrent bone marrow involvement by AML/MDS, pOS values were 0.56 ± 0.12 and 0.84 ± 0.09 (p=0.0251), respectively, and pEFS values were 0.56 ± 0.12 and 0.82 ± 0.08 (p=0.0247), respectively. In patients with and without the t(8;21)(q22;q22) translocation, pEFS values were 0.90 ± 0.09 and 0.51 ± 0.14 (p=0.0490), respectively.ConclusionsMS is a disease with a highly variable clinical course. Worse treatment outcomes were observed in patients with isolated MS compared to those with concurrent bone marrow involvement by AML/MDS. Patients with the t(8;21)(q22;q22) translocation were found to have significantly higher pEFS. MS location, age group, chemotherapy regimen, surgery, and/or radiotherapy did not have a significant influence on treatment outcomes. Further exploration of prognostic factors in children with MS is indicated.
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Affiliation(s)
- Magdalena Samborska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
- *Correspondence: Magdalena Samborska,
| | - Małgorzata Barańska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
| | - Sheanda Thambyrajah
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
| | - Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Kraków, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Kraków, Poland
| | - Sylwia Kołtan
- Department of Paediatrics, Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Katarzyna Peszyńska-Żelazny
- Department of Paediatrics, Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Mariusz Wysocki
- Department of Paediatrics, Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-oncology and Pediatric Gastroenterology, Independent Public Clinical Hospital No. 1, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-oncology and Pediatric Gastroenterology, Independent Public Clinical Hospital No. 1, Pomeranian Medical University, Szczecin, Poland
| | - Grażyna Wróbel
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Supraregional Center of Pediatric Oncology “Cape of Hope”, Wrocław, Poland
| | - Jadwiga Węcławek-Tompol
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Supraregional Center of Pediatric Oncology “Cape of Hope”, Wrocław, Poland
| | - Bogna Ukielska
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Supraregional Center of Pediatric Oncology “Cape of Hope”, Wrocław, Poland
| | - Alicja Chybicka
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Supraregional Center of Pediatric Oncology “Cape of Hope”, Wrocław, Poland
| | - Anna Kitszel
- Department of Pediatrics, Oncology and Hematology, L. Children’s Clinical Hospital, Białystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatrics, Oncology and Hematology, L. Children’s Clinical Hospital, Białystok, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Oncology and Hematology, Independent Public Children’s Teaching Hospital, Warsaw, Poland
| | - Iwona Malinowska
- Department of Pediatric Oncology and Hematology, Independent Public Children’s Teaching Hospital, Warsaw, Poland
| | - Michał Matysiak
- Department of Pediatric Oncology and Hematology, Independent Public Children’s Teaching Hospital, Warsaw, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Renata Tomaszewska
- Department of Pediatrics, Pediatric Hematology and Oncology in Zabrze, Stanisław Szyszko Independent Public University Hospital No. 1, Medical University of Silesia, Katowice, Poland
| | - Tomasz Szczepański
- Department of Pediatrics, Pediatric Hematology and Oncology in Zabrze, Stanisław Szyszko Independent Public University Hospital No. 1, Medical University of Silesia, Katowice, Poland
| | | | - Grażyna Karolczyk
- Department of Pediatric Oncology and Hematology, Provincial Integrated Hospital, Kielce, Poland
| | | | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, University Clinical Centre, Gdańsk, Poland
| | - Wanda Badowska
- Department of Pediatric Oncology and Hematology, Provincial Specialist Children’s Hospital, Olsztyn, Poland
| | - Michał Dopierała
- Department of Clinical Pathology, Poznań University of Medical Sciences, Poznań, Poland
| | - Paweł Kurzawa
- Department of Clinical Pathology, Poznań University of Medical Sciences, Poznań, Poland
| | - Katarzyna Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
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11
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Salou S, Feige U, Antoniou E, Flotho C. Priapism from myeloid sarcoma of the sacral canal in a 6-year-old patient. Pediatr Hematol Oncol 2022; 39:83-88. [PMID: 34016030 DOI: 10.1080/08880018.2021.1928803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sarah Salou
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ursula Feige
- Department of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Evangelia Antoniou
- AML-BFM Study Group, Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Duisburg-Essen, Essen, Germany
| | - Christian Flotho
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Freiburg, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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12
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Ye F, Zhang H, Zhang W, Dong J, Deng W, Yang L. Clinical characteristics, pathology features and outcomes of pediatric myeloid sarcoma: A retrospective case series. Front Pediatr 2022; 10:927894. [PMID: 36545668 PMCID: PMC9760868 DOI: 10.3389/fped.2022.927894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Myeloid sarcoma (MS) is a rare extramedullary mass with myeloid expression, which is easy to be missed and misdiagnosed, especially in the pediatric population. We analyze the clinicopathological characteristics, immunophenotypic, cytogenetic, and molecular studies, therapeutic approaches, and outcomes, to optimize the management of such patients. METHODS A retrospective, single-center, case series study of eleven children diagnosed with MS by pathology was performed. RESULTS The male-to-female ratio was 8:3, and the median age at diagnosis was 7 years. The most commonly involved sites were the skin and orbital region, followed by lymph nodes, central nervous system, and testis. Seven cases (64%) with Class I-MS and four cases (36%) presented as Class II-MS. Immunohistochemically, MPO and CD117 were the most commonly expressed markers, followed by CD33, CD43, CD34, CD68, and lysozyme. Chromosomal abnormalities were detected in 4 patients. Two patients had the presence of deleterious mutations (FLT3, ASXL, KIT, and DHX15) on molecular detection. Ten patients were treated with chemotherapy based on AML regimens. The median follow-up time was 33.5 months in eleven patients. Two patients relapsed, one died, and one lost to follow-up. The 2-year overall survival (OS) rate estimated by Kaplan-Meier curves was 90.9% ± 8.7%, and the event-free survival (EFS) rate was 64.9% ± 16.7%. CONCLUSIONS MS diagnosis is usually challenging. Adequate tumor biopsy and expanded immunohistochemistry are necessary for the correct diagnosis of MS. Early and regular systemic chemotherapy promises long-term survival.
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Affiliation(s)
- Fanghua Ye
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Hui Zhang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Wen Zhang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Jiajia Dong
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Wenjun Deng
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
| | - Liangchun Yang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, China
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13
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Myeloid Sarcoma of the Testis in Children: Clinicopathologic and Immunohistochemical Characteristics With KMT2A (MLL) Gene Rearrangement Correlation. Appl Immunohistochem Mol Morphol 2021; 28:501-507. [PMID: 31241561 DOI: 10.1097/pai.0000000000000783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Myeloid sarcoma (MS) is defined as an extramedullary mass-forming lesion composed of immature myeloid cells. It is a rare but well-known manifestation of acute myeloid leukemia. Pediatrics testicular MS may pose a possible diagnostic challenge, an issue that is underscored in the few testicular pediatric MS cases reported in the literature. Herein, we report a series of 5 cases of pediatric testicular MS that are evaluated at the morphologic and immunohistochemical levels with correlation with the KMT2A (MLL) rearrangement status. Three patients presented with no prior history of acute myeloid leukemia. All 5 cases showed monoblastic morphology; positive for CD33, CD43, CD68, CD163, CD4 (dim), and lysozyme; and negative for CD10, CD34, CD117, and myeloperoxidase. KMT2A (MLL) rearrangement was detected in 4 of the 5 cases. In the literature, 8 more cases of pediatric testicular lymphoma were reported. Most of them showed monocytic differentiation and KMT2A (MLL) rearrangement was reported in 3 of the cases. In conclusions, testicular MS in pediatric patients shows monoblastic differentiation which may be attributed to the KMT2A (MLL) rearrangement. We also highlight the importance of using an extended immunohistochemistry panel in the diagnosis of MS.
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14
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Chen N, Lin CS, Hsu YH, Huang WH, Huang CT, Lee YC. Acute Myeloid Leukemia Transformation from Myelofibrosis Upon Remission of an Orbital Myeloid Sarcoma - A Case Report. Int Med Case Rep J 2021; 14:443-448. [PMID: 34234577 PMCID: PMC8256097 DOI: 10.2147/imcrj.s310230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report a case of an orbital myeloid sarcoma concurrent with JAK2 mutation myelofibrosis, which rapidly transformed into acute myeloid leukemia upon aggressive treatment. RESULTS A 51-year-old woman had progressive swelling of periorbita for one month. Magnetic resonance imaging demonstrated a well-defined, mild enhanced mass indenting the adjacent right lateral rectus muscle and the globe. Biopsy from anterior orbitotomy revealed an orbital myeloid sarcoma. Bone marrow study showed concurrent myelofibrosis. Although the orbital lesion subsided remarkably under aggressive chemotherapy and radiotherapy, the leukemic transformation was noticed in the third month following the initial presentation. CONCLUSION This case demonstrated that myeloid sarcoma should be included in the differential diagnosis of orbital diseases, with or without involvement of hematological disorders. Early diagnosis and aggressive treatment as for AML are crucial as the prognosis is usually poor for adult orbital MS.
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Affiliation(s)
- Nancy Chen
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Chia-Shuen Lin
- Department of Dermatology, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Yung-Hsiang Hsu
- Department of Pathology, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Wei-Han Huang
- Department of Clinical Pathology, Hualien Tzu Chi Hospital, Hualien, Taiwan
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Chin-Te Huang
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yuan-Chieh Lee
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Hualien, Taiwan
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15
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Mesothelin is a novel cell surface disease marker and potential therapeutic target in acute myeloid leukemia. Blood Adv 2021; 5:2350-2361. [PMID: 33938941 PMCID: PMC8114558 DOI: 10.1182/bloodadvances.2021004424] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/02/2021] [Indexed: 12/20/2022] Open
Abstract
In an effort to identify acute myeloid leukemia (AML)-restricted targets for therapeutic development in AML, we analyzed the transcriptomes of 2051 children and young adults with AML and compared the expression profile with normal marrow specimens. This analysis identified a large cohort of AML-restricted genes with high expression in AML, but low to no expression in normal hematopoiesis. Mesothelin (MSLN), a known therapeutic target in solid tumors, was shown to be highly overexpressed in 36% of the AML cohort (range, 5-1077.6 transcripts per million [TPM]) and virtually absent in normal marrow (range, 0.1-10.7 TPM). We verified MSLN transcript expression by quantitative reverse transcription polymerase chain reaction, confirmed cell surface protein expression on leukemic blasts by multidimensional flow cytometry, and demonstrated that MSLN expression was associated with promoter hypomethylation. MSLN was highly expressed in patients with KMT2A rearrangements (P < .001), core-binding factor fusions [inv(16)/t(16;16), P < .001; t(8;21), P < .001], and extramedullary disease (P = .001). We also demonstrated the presence of soluble MSLN in diagnostic serum specimens using an MSLN-directed enzyme-linked immunosorbent assay. In vitro and in vivo preclinical efficacy of the MSLN-directed antibody-drug conjugates (ADCs) anetumab ravtansine and anti-MSLN-DGN462 were evaluated in MSLN+ leukemia cell lines in vitro and in vivo, as well as in patient-derived xenografts. Treatment with ADCs resulted in potent target-dependent cytotoxicity in MSLN+ AML. In this study, we demonstrate that MSLN is expressed in a significant proportion of patients with AML and holds significant promise as a diagnostic and therapeutic target in AML, and that MSLN-directed therapeutic strategies, including ADCs, warrant further clinical investigation.
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16
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Manpreet S, Sagarika S, Pulkit R, Kalaivani J, Manpreet K, Pankaj G. Acute unilateral proptosis in childhood: suspect myeloid sarcoma. Rom J Ophthalmol 2021; 65:85-88. [PMID: 33817441 PMCID: PMC7995499 DOI: 10.22336/rjo.2021.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
As the first and only presenting feature of acute myeloid leukemia (AML), unilateral proptosis in children is uncommon. We report the cases of two girls who had no systemic clinical manifestations of AML. Orbital imaging showed space-occupying infiltrating lesions without surrounding bone erosion. Incisional biopsy and immunohistochemistry were diagnostic for myeloid sarcoma. Systemic workup and bone marrow examination showed features of AML. Systemic chemotherapy was administered to both children, who responded well to the treatment. Myeloid sarcoma should be kept in the differentials of the children presenting with isolated proptosis. Immunohistochemistry may provide an accurate diagnosis and early treatment may lead to a prompt recovery with a good prognosis.
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Affiliation(s)
- Singh Manpreet
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Snehi Sagarika
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rastogi Pulkit
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayakumar Kalaivani
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kaur Manpreet
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gupta Pankaj
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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17
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Sakaguchi H, Miyamura T, Tomizawa D, Taga T, Ishida H, Okamoto Y, Koh K, Yokosuka T, Yoshida N, Sato M, Noguchi M, Okada K, Hori T, Takeuchi M, Kosaka Y, Inoue M, Hashii Y, Atsuta Y. Effect of extramedullary disease on allogeneic hematopoietic cell transplantation for pediatric acute myeloid leukemia: a nationwide retrospective study. Bone Marrow Transplant 2021; 56:1859-1865. [PMID: 33692532 DOI: 10.1038/s41409-021-01250-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 01/27/2021] [Accepted: 02/17/2021] [Indexed: 11/09/2022]
Abstract
Children with acute myeloid leukemia (AML) commonly develop extramedullary disease (EMD), which comprises central nervous system (CNS) lesions and myeloid sarcoma (MS). In this retrospective analysis, we aimed to determine the effect of EMD on the outcomes of allogeneic hematopoietic cell transplantation (HCT) in 678 pediatric patients with de novo AML (median age, 7 years; range, 0.3-15 years) between 2006 and 2016. We compared the outcomes between patients with (EMD group, n = 158; CNS lesion, n = 47, CNS lesion + MS, n = 9, and MS, n = 102) and without EMD at diagnosis (non-EMD group, n = 520). Survivors were followed for a median of 4.5 years, and the 4-year overall survival (OS) rates were 60.6% and 56.4% in the EMD and non-EMD groups, respectively (P = 0.60). No significant differences in OS were observed with respect to the EMD site, except bone lesions, which were associated with poor OS after HCT in a non-remission status. A multivariate analysis revealed that EMD did not affect the outcomes of HCT. In conclusion, the study findings suggest that EMD should not be considered a poor prognostic factor in HCT for children with AML.
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Affiliation(s)
- Hirotoshi Sakaguchi
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan. .,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.
| | - Takako Miyamura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daisuke Tomizawa
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Taga
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | | | - Yasuhiro Okamoto
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Tomoko Yokosuka
- Division of Hematology/Oncology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Nao Yoshida
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Maho Sato
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Maiko Noguchi
- Department of Pediatrics, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Keiko Okada
- Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University Hospital, Sapporo, Japan
| | - Masanobu Takeuchi
- Department of Pediatrics, Yokohama City University Hospital, Yokohama, Japan
| | - Yoshiyuki Kosaka
- Department of Hematology and Oncology, Center of Childhood Cancer, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yoshiko Hashii
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Cancer Immunotherapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Hu G, Lu A, Wu J, Jia Y, Zuo Y, Ding M, Zhang L. Characteristics and prognosis of pediatric myeloid sarcoma in the cytogenetic context of t(8;21). Pediatr Hematol Oncol 2021; 38:14-24. [PMID: 32803999 DOI: 10.1080/08880018.2020.1803462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prognosis of myeloid sarcoma (MS) is controversial. Many reports indicated that orbital-MS has a good prognosis and is closely related to t(8;21), but the prognostic role of MS in pediatric t(8;21) AML is unclear. We retrospectively analyzed data from 127 patients with pediatric t(8;21) AML diagnosed between January 2010 and June 2018. We compared patients with (n = 30) and without MS (n = 97). The median follow-up time was 52.6 months. The proportion of t(8;21) AML patients with MS was 23.6%. Males were more likely to have MS than females. The complete remission rate after the first course of induction chemotherapy and the 3-year relapse-free survival (RFS) among patients with MS were lower than those among patients without MS (60% vs. 78.4%, p = 0.045) (68.8 ± 8.8% vs. 88.0 ± 3.4%, p = 0.004). The female sex and a higher level of RUNX1/RUNX1T1 transcripts after consolidation were risk factors for poor RFS among patients with MS. Our data showed that MS was an independent risk factor in pediatric t(8;21) AML. Close monitoring of measurable residual disease of the bone marrow and extramedullary lesions is needed to guide stratified treatment.
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Affiliation(s)
- Guanhua Hu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Aidong Lu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Jun Wu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Yueping Jia
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Yingxi Zuo
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Mingming Ding
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Leping Zhang
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
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19
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Bilateral Ocular Exophthalmia - A Case of Atypical Acute Myeloblastic Leukemia in a Child. ACTA ACUST UNITED AC 2020; 6:243-248. [PMID: 33200096 PMCID: PMC7648444 DOI: 10.2478/jccm-2020-0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/29/2020] [Indexed: 01/23/2023]
Abstract
Introduction In acute myeloblastic leukaemia (AML) explosive proliferation and accumulation of immature myeloid cell clones take place, replacing the bone marrow, with the possibility of the formation of extramedullary tumour masses composed of myeloid cells. The onset of the disease less frequently consists of symptoms of extramedullary manifestation. Case presentation A Caucasian male child aged three years and 11 months was hospitalized for bilateral exophthalmos and otorrhea, due to an alteration in his general condition. Ocular ultrasound revealed an inhomogeneous thickening of the upper right muscles superior to the eyeball. A complete blood count showed severe anaemia, leucocytosis with neutropenia and thrombocytopenia. A peripheral blood smear evidenced myeloblasts. The result of the cytology of bone marrow confirmed the diagnosis of AML. Following blood product replacements and cytostatic treatment (AML-BFM 2004 HR protocol), the remission of exophthalmos and the correction of haematological parameters were favourable. Conclusion In a child with a sudden onset of exophthalmia and altered general condition, the diagnosis of acute leukaemia should be considered. The importance of performing a peripheral blood smear and bone marrow examination is emphasized so that diagnosis and initiation of treatment are not delayed.
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20
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Hu GH, Lu AD, Jia YP, Zuo YX, Wu J, Zhang LP. Prognostic Impact of Extramedullary Infiltration in Pediatric Low-risk Acute Myeloid Leukemia: A Retrospective Single-center Study Over 10 Years. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e813-e820. [PMID: 32680776 DOI: 10.1016/j.clml.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The impact of extramedullary infiltration (EMI) on the clinical outcomes of pediatric patients with acute myeloid leukemia (AML) are controversial. PATIENTS AND METHODS A total of 214 pediatric patients with low-risk AML were classified as having EMI (central nervous leukemia [CNSL] and/or myeloid sarcoma [MS]) and not having EMI. Patients with isolated MS before AML diagnosis by bone marrow examination were confirmed with histopathologic examination. For patients diagnosed with AML by bone marrow examination, a thorough physical examination and radiologic imaging were used to confirm MS. RESULTS Male gender, a high white blood cell count, the FAB-M5 subtype, t(8;21) and t(1;11) abnormalities, and c-KIT mutations were associated with EMI. The presence of MS was associated with a low complete remission rate (63.6% vs. 79.4%; P = .000) and poor 3-year relapse-free survival (RFS) (62.6% ± 7.5% vs. 87.0% ± 2.8%; P = .000) and 3-year overall survival (73.5% ± 7% vs. 88.8% ± 2.6%; P = .011). Multivariate analysis revealed that MS was a poor prognostic factor for RFS and overall survival. Bone infiltration was an independent risk factor for inferior RFS with MS. Patients with CNSL had a low complete remission rate (58.3% vs. 77.2%; P = .045); however, CNSL did not significantly affect the survival of low-risk patients with AML. CONCLUSION MS should be considered an independent risk factor to guide stratified treatment.
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Affiliation(s)
- Guan-Hua Hu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Ai-Dong Lu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Yue-Ping Jia
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Ying-Xi Zuo
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Jun Wu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Le-Ping Zhang
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China.
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21
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Successful Treatment of Relapsed Pediatric Acute Myeloid Leukemia Presenting as Central Nervous System Myeloid Sarcoma: A Single-Institution Case Series. J Pediatr Hematol Oncol 2020; 42:319-321. [PMID: 30543582 DOI: 10.1097/mph.0000000000001383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Relapsed acute myeloid leukemia presenting as an isolated central nervous system myeloid sarcoma (CNS MS) is very rare and generally entails poor outcomes. CNS MS treatment is not well defined and can include systemic chemotherapy, intrathecal chemotherapy, radiation therapy, or hematopoietic stem cell transplant. Thiotepa, vinorelbine, topotecan, and clofarabine (TVTC) has been successful for reinduction therapy in relapsed/refractory leukemia to induce remission before hematopoietic stem cell transplant. There is no published evidence of TVTC being utilized for CNS MS. In this series, we report 2 symptomatic patients with isolated CNS MS at relapse who demonstrated near complete resolution after reinduction with TVTC and additional intrathecal chemotherapy.
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22
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Prognostic Role of Postinduction Minimal Residual Disease and Myeloid Sarcoma Type Extramedullary Involvement in Pediatric RUNX1-RUNX1T1 (+) Acute Myeloid Leukemia. J Pediatr Hematol Oncol 2020; 42:e132-e139. [PMID: 31688618 DOI: 10.1097/mph.0000000000001623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Acute myeloid leukemia with the t(8;21)(q22;q22) rearrangement (RUNX1-RUNX1T1 (+) AML) is known to have a favorable prognosis. Our study aimed to determine the most important prognostic variables among an aggregate of clinical, genetic, and treatment response-based factors in pediatric RUNX1-RUNX1T1 (+) AML. MATERIALS AND METHODS We analyzed the characteristics and outcome of 40 patients who were diagnosed with and treated for RUNX1-RUNX1T1 (+) AML from April 2008 to December 2016 at our institution. RESULTS A<-2.2 log fusion transcript decrement after remission induction, myeloid sarcoma type extramedullary involvement (EMI) at diagnosis, higher initial white blood cell count, and presence of KIT mutation predicted lower event-free survival. Both lower fusion transcript decrement after remission induction and the presence of EMI at diagnosis proved to be significant adverse factors in the multivariate study. The 5-year event-free survival was 70.0±7.2% (28/40); 8 of the 12 relapsed patients survive disease-free, resulting in 5-year overall survival of 89.5±5.0% (36/40). CONCLUSIONS Kinetics of response to remission induction chemotherapy, measured in terms of the PCR value for the fusion transcript, and the presence of myeloid sarcoma type EMI at diagnosis may predict the risk of relapse in pediatric RUNX1-RUNX1T1 (+) AML.
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23
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Feeling Green. Can J Neurol Sci 2020. [DOI: 10.1017/cjn.2019.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Zhou T, Bloomquist MS, Ferguson LS, Reuther J, Marcogliese AN, Elghetany MT, Roy A, Rao PH, Lopez-Terrada DH, Redell MS, Punia JN, Curry CV, Fisher KE. Pediatric myeloid sarcoma: a single institution clinicopathologic and molecular analysis. Pediatr Hematol Oncol 2020; 37:76-89. [PMID: 31682773 DOI: 10.1080/08880018.2019.1683107] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Myeloid sarcoma (MS) is a neoplastic condition composed of immature myeloid cells involving an extramedullary site. We investigated underlying chromosomal and molecular alterations to assess potential molecular markers of prognosis and outcome in this rare pediatric disease. We conducted a retrospective review of clinicopathologic and cytogenetic data from 33 pediatric patients with MS (ages 1 month-18 years) at our institution over a 32 year period (1984-2016). Tissue-based cancer microarray and targeted next-generation sequencing analysis were performed on six cases. The median age at diagnosis was 2.8 years with a male-to-female ratio of 2.6:1. MS is commonly presented with concomitant marrow involvement (n = 12, 36.4%) or as a recurrence of acute myeloid leukemia (AML; n = 14, 42.4%). The skin (n = 18, 54.5%) and soft tissue (n = 9, 27.3%) were the most common sites of involvement. Twenty-one of 25 samples (84.0%) harbored chromosomal aberrations; KMT2A alterations (n = 10, 40.0%) or complex cytogenetics (n = 7, 28.0%) were most frequent. Mutations in RAS, tyrosine kinase, cell signaling, and chromatin remodeling genes were detected. When compared to pediatric patients with AML without extramedullary involvement (EMI), inferior overall survival (OS) was observed (18.8 months vs. 89.3 months, p = .008). Pediatric patients with MS with non-favorable cytogenetics [abnormalities other than t(8;21), inv(16)/t(16;16), or t(15;17)] had a significantly lower OS compared to patients with AML with non-favorable cytogenetics and no extramedullary involvement (8.0 months vs. 28.1 months, p < .001). Pediatric MS is a rare disease with diverse clinical presentations. Non-favorable cytogenetics may be a poor prognostic marker for pediatric patients with MS and molecular diagnostics can assist with risk stratification and identify potentially actionable targets.
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Affiliation(s)
- Ting Zhou
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - M Suzanne Bloomquist
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jacquelyn Reuther
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Andrea N Marcogliese
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - M Tarek Elghetany
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Angshumoy Roy
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Pulivarthi H Rao
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Dolores H Lopez-Terrada
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Michele S Redell
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jyotinder N Punia
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Choladda V Curry
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Kevin E Fisher
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA.,Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
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25
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Abstract
PURPOSE OF REVIEW Despite advances in therapy over the past decades, overall survival for children with acute myeloid leukemia (AML) has not exceeded 70%. In this review, we highlight recent insights into risk stratification for patients with pediatric AML and discuss data driving current and developing therapeutic approaches. RECENT FINDINGS Advances in cytogenetics and molecular profiling, as well as improvements in detection of minimal residual disease after induction therapy, have informed risk stratification, which now relies heavily on these elements. The treatment of childhood AML continues to be based primarily on intensive, conventional chemotherapy. However, recent trials focus on limiting treatment-related toxicity through the identification of low-risk subsets who can safely receive fewer cycles of chemotherapy, allocation of hematopoietic stem-cell transplant to only high-risk patients and optimization of infectious and cardioprotective supportive care. SUMMARY Further incorporation of genomic and molecular data in pediatric AML will allow for additional refinements in risk stratification to enable the tailoring of treatment intensity. These data will also dictate the incorporation of molecularly targeted therapeutics into frontline treatment in the hope of improving survival while decreasing treatment-related toxicity.
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Xu LH, Wang Y, Chen ZY, Fang JP. Myeloid sarcoma is associated with poor clinical outcome in pediatric patients with acute myeloid leukemia. J Cancer Res Clin Oncol 2020; 146:1011-1020. [PMID: 31919567 DOI: 10.1007/s00432-020-03128-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/06/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE The impact of myeloid sarcoma (MS) on clinical outcome of pediatric acute myeloid leukemia (AML) patients remains controversial. Moreover, little is known about the role of stem cell transplantation (SCT) in such patients. METHODS Clinical data of patients with AML under 18 years of age were retrieved from the TARGET dataset. We analyzed the prevalence, clinical profile, molecular characteristics, and prognosis of MS in these patients. RESULTS Among 884 pediatric patients with AML, the frequency of MS was 12.3%. Pediatric AML with MS was associated with age under 1-year, abnormal cytogenetics, and KMT2A rearrangement. Moreover, MS was associated with a low complete remission rate, high induction death, poor 5-year EFS, and OS. KMT2A rearrangement had a negative impact on clinical outcome in AML patients with MS. In addition, SCT had no significant effect on the survival of AML patients with MS. Multivariate analysis revealed that MS was an unfavorable prognostic factor in pediatric AML in terms of EFS (Hazard ratio 1.670, P < 0.001) and OS (Hazard ratio 1.623, P = 0.004). CONCLUSIONS The presence of MS at diagnosis of pediatric AML is associated with poor clinical outcomes, particularly when associated with KMT2A rearrangements. Moreover, pediatric patients with AML and MS may not benefit from SCT.
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Affiliation(s)
- Lu-Hong Xu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107, West Yan Jiang Road, Guangzhou, Guangdong Province, People's Republic of China.
| | - Yin Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107, West Yan Jiang Road, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhi-Yuan Chen
- Department of Pulmonary, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jian-Pei Fang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107, West Yan Jiang Road, Guangzhou, Guangdong Province, People's Republic of China.
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Skarsgård LS, Andersson MK, Persson M, Larsen AC, Coupland SE, Stenman G, Heegaard S. Clinical and genomic features of adult and paediatric acute leukaemias with ophthalmic manifestations. BMJ Open Ophthalmol 2019; 4:e000362. [PMID: 31673633 PMCID: PMC6797369 DOI: 10.1136/bmjophth-2019-000362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/27/2019] [Accepted: 09/07/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To describe the clinicopathological and genomic features of nine patients with primary and secondary orbital/ocular manifestations of leukaemia. Methods All orbital/ocular leukaemic specimens from 1980 to 2009 were collected from the Danish Register of Pathology. In six cases, medical records and formalin-fixed, paraffin-embedded blocks were available. Three cases from the Department of Pathology, Royal Liverpool University Hospital, were also included. Immunophenotypes and MYB oncoprotein expression were ascertained by immunohistochemistry. Genomic imbalances were analysed with comparative genomic hybridisation arrays and oncogene rearrangements with fluorescence in situ hybridisation. Results Four patients had B-cell precursor acute lymphoblastic leukaemia (BCP-ALL) and five had acute myeloid leukaemia (AML). Two patients with BCP-ALL and one with AML had primary orbital manifestations of leukaemia. Common symptoms were proptosis, displacement of the eye, and reduced eye mobility in patients with orbital leukaemias and pain, and reduced visual acuity in patients with ocular leukaemias. All patients with primary orbital lesions were alive up to 18 years after diagnosis. All but one patient with secondary ophthalmic manifestations died of relapse/disseminated disease. ETV6 and RUNX1 were rearranged in BCP-ALL, and RUNX1 and KMT2A in AML. Genomic profiling revealed quiet genomes (0–7 aberrations/case). The MYB oncoprotein was overexpressed in the majority of cases. Conclusions Leukaemias with and without ophthalmic manifestations have similar immunophenotypes, translocations/gene fusions and copy number alterations. Awareness of the clinical spectrum of leukaemic lesions of the eye or ocular region is important to quickly establish the correct diagnosis and commence prompt treatment.
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Affiliation(s)
- Lisa Stenman Skarsgård
- Department of Surgery, Ostfold Hospital Trust, Fredrikstad, Norway.,Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mattias K Andersson
- Sahlgrenska Cancer Center, Department of Pathology, University of Gothenburg, Gothenburg, Sweden
| | - Marta Persson
- Sahlgrenska Cancer Center, Department of Pathology, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Cathrine Larsen
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.,Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, UK
| | - Göran Stenman
- Sahlgrenska Cancer Center, Department of Pathology, University of Gothenburg, Gothenburg, Sweden
| | - Steffen Heegaard
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
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28
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Chen SM, Silverman DA, Jatana KR, Chiang T, Guinipero T, Hill N, Siu JJ, Reed S. Myeloid sarcoma presenting as bilateral acute otitis externa in newly diagnosed acute myeloid leukemia. Int J Pediatr Otorhinolaryngol 2019; 122:126-129. [PMID: 31005747 DOI: 10.1016/j.ijporl.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
Myeloid sarcoma (MS) is an extramedullary collection of immature myeloid cells that can commonly occur with acute myeloid leukemia (AML). While head and neck presentations are not unheard of, there have been few published pediatric cases of external auditory canal MS. Here, we report a case of a 14-year-old male who presented with MS masquerading as bilateral acute otitis externa. To the best of our knowledge, this is the first reported case of a bilateral presentation leading to a new diagnosis of AML. A literature review of head and neck presentations of MS is included.
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Affiliation(s)
- Sarah M Chen
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Dustin A Silverman
- Department of Otolaryngology - Head & Neck Surgery, Nationwide Children's Hospital, Wexner Medical Center at Ohio State University, Columbus, OH, USA
| | - Kris R Jatana
- Department of Otolaryngology - Head & Neck Surgery, Nationwide Children's Hospital, Wexner Medical Center at Ohio State University, Columbus, OH, USA
| | - Tendy Chiang
- Department of Otolaryngology - Head & Neck Surgery, Nationwide Children's Hospital, Wexner Medical Center at Ohio State University, Columbus, OH, USA
| | - Terri Guinipero
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nina Hill
- The Ohio State University College of Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jason J Siu
- The Ohio State University College of Medicine, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Suzanne Reed
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
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29
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Clinical and Radiographic Response of Extramedullary Leukemia in Patients Treated With Gemtuzumab Ozogamicin. J Pediatr Hematol Oncol 2019; 41:e174-e176. [PMID: 29734213 DOI: 10.1097/mph.0000000000001201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Extramedullary leukemia (EML) is common in pediatric acute leukemia and can present at diagnosis or relapse. CD33 is detected on the surface of myeloid blasts in many patients with acute myelogenous leukemia and is the target of the antibody drug conjugate gemtuzumab ozogamicin (GO). Here we present 2 patients with CD33 EML treated with GO. They achieved significant response, with reduction of EML on both clinical and radiographic exams, specifically fluorine fluorodeoxyglucose positron emission tomography/computed tomography, demonstrating potential for targeted therapy with GO as a means of treating EML in patients with CD33 leukemia and the utility of fluorine fluorodeoxyglucose positron emission tomography/computed tomography monitoring in EML.
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30
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Circular RNA regulatory network reveals cell-cell crosstalk in acute myeloid leukemia extramedullary infiltration. J Transl Med 2018; 16:361. [PMID: 30558617 PMCID: PMC6297994 DOI: 10.1186/s12967-018-1726-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022] Open
Abstract
Background Acute myeloid leukemia can develop as myoblasts infiltrate into organs and tissues anywhere other than the bone marrow, which called extramedullary infiltration (EMI), indicating a poor prognosis. Circular RNAs (circRNAs) are a novel class of non-coding RNAs that feature covalently closed continuous loops, suggesting their potential as micro RNA (miRNA) “sponges” that can participate in biological processes and pathogenesis. However, investigations on circRNAs in EMI were conducted rarely. In this study, the overall alterations of circRNAs and their regulatory network between EMI and non-EMI AML were delineated. Methods CircRNA and whole genome microarrays derived from EMI and non-EMI AML bone marrow mononuclear cells were carried out. Functional analysis was performed via Gene Ontology and KEGG test methods. The speculated functional roles of circRNAs were based on mRNAs and predicted miRNAs that played intermediate roles. Integrated bioinformatic analysis was conducted to further characterize the circRNA/miRNA/mRNA regulatory network and identify the functions of distinct circRNAs. The Cancer Genome Atlas (TCGA) data were acquired to evaluate the poor prognosis of distinct target genes of circRNAs. Reverse transcription-quantitative polymerase chain reaction was conducted to identify the expression of has_circRNA_0004520. Connectivity map (CMap) analysis was further performed to predict potential therapeutic agents for EMI. Results 253 circRNAs and 663 genes were upregulated and 259 circRNAs and 838 genes were downregulated in EMI compared to non-EMI AML samples. GO pathways were enriched in progress including cell adhesion (GO:0030155; GO:0007155), migration (GO:0016477; GO:0030334), signal transduction (GO:0009966; GO:0007165) and cell–cell communication. Overlapping circRNAs envolved in pathways related to regulate cell–cell crosstalk, 17 circRNAs were chosen based on their putative roles. 7 target genes of 17 circRNAs (LRRK1, PLXNB2, OLFML2A, LYPD5, APOL3, ZNF511, and ASB2) indicated a poor prognosis, while overexpression of PAPLN and NRXN3 indicated a better one based on data from TCGA. LY-294002, trichostatin A and SB-202190 were identified as therapeutic candidates for EMI by the CMap analysis. Conclusion Taken together, this study reveals the overall alterations of circRNA and mRNA involved in EMI and suggests potential circRNAs may act as biomarkers and targets for early diagnosis and treatment of EMI. Electronic supplementary material The online version of this article (10.1186/s12967-018-1726-x) contains supplementary material, which is available to authorized users.
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31
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Foster JH, Williams CL, Elghetany MT, Liu P, Krance RA, Bertuch AA, Gramatges MM. Monozygotic twins with non-Down syndrome associated MLL-rearranged hematologic malignancy and megakaryoblastic differentiation. Leuk Lymphoma 2018; 60:1083-1086. [DOI: 10.1080/10428194.2018.1516883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jennifer H. Foster
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Chris L. Williams
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Mohamed Tarek Elghetany
- Texas Children's Hospital, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
- Department of Pathology, Division of Anatomic Pathology, Baylor College of Medicine, Houston, TX, USA
| | - Pengfei Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Robert A. Krance
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Alison A. Bertuch
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Maria Monica Gramatges
- Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
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Taga T, Imamura T, Nakashima K, Maeda N, Watanabe A, Miyajima Y, Sakaguchi S, Sano H, Hasegawa D, Kawasaki H, Adachi S, Takagi M, Koh K, Manabe A, Taki T, Ishida Y. Clinical characteristics of pediatric patients with myeloid sarcoma without bone marrow involvement in Japan. Int J Hematol 2018; 108:438-442. [DOI: 10.1007/s12185-018-2492-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
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Myeloid Sarcoma Predicts Superior Outcome in Pediatric AML; Can Cytogenetics Solve the Puzzle? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e249-e254. [DOI: 10.1016/j.clml.2018.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/13/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022]
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Acute Myeloid Leukemia With Central Nervous System Involvement in Children: Experience From the French Protocol Analysis ELAM02. J Pediatr Hematol Oncol 2018; 40:43-47. [PMID: 29189507 DOI: 10.1097/mph.0000000000001034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Central nervous system (CNS) involvement at diagnosis of pediatric acute myeloid leukemia (AML) is not considered as an independent prognostic factor. This study describes the prognostic value of pediatric AML with CNS involvement at diagnosis. Pediatric patients were treated for de novo AML in the French multicenter trial ELAM02. Lumbar puncture was carried out in the first week, and the treatment was adapted to the CNS status. No patient received CNS radiotherapy. The patients were classified into 2 groups: CNS+ and CNS-. Of the 438 patients, 16% (n=70) had CNS involvement at diagnosis, and 29% showed clinical signs. The patients with CNS disease were younger (40% were below 2 y old), had a higher white blood cell count (median of 45 vs. 13 G/L), and had M4 and M5 morphologies. The complete remission rate was similar at 92.8% for CNS+ and 88.5% for CNS-. There was no significant difference between the CNS+ and the CNS- group in overall survival (76% and 71%, respectively) and event-free survival (57% and 52%, respectively). Regarding the occurrence of first relapse, the CNS+ group had a higher combined relapse rate of 26.1% compared with 10% for the CNS- group. The results indicate that CNS involvement at diagnosis of pediatric AML is not an independent prognostic factor. Triple intrathecal chemotherapy combined with high-dose intravenous cytarabine should be the first-line treatment for CNS disease.
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35
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Ranta S, Palomäki M, Levinsen M, Taskinen M, Abrahamsson J, Hasle H, Jahnukainen K, Heyman M, Harila-Saari A. Presenting features and imaging in childhood acute myeloid leukemia with central nervous system involvement. Pediatr Blood Cancer 2017; 64. [PMID: 28233411 DOI: 10.1002/pbc.26459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/29/2016] [Accepted: 12/25/2016] [Indexed: 11/05/2022]
Abstract
Central nervous system (CNS) involvement in childhood acute myeloid leukemia (AML) can manifest as leukemic cells in the cerebrospinal fluid, a solid CNS tumor, or as neurological symptoms. We evaluated the presenting symptoms and neuroimaging findings in 33 of 34 children with AML and CNS involvement at diagnosis in the period 2000-2012 in Sweden, Finland, and Denmark. Imaging was performed in 22 patients, of whom 16 had CNS-related symptoms. Seven patients, including all but two with facial palsy, had mastoid cell opacification, considered an incidental finding. The frequent involvement of the mastoid bone with facial palsy warrants evaluation in larger series.
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Affiliation(s)
- Susanna Ranta
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Maarit Palomäki
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Mette Levinsen
- Department of Pediatrics and Adolescent Medicine, The University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mervi Taskinen
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland
| | - Jonas Abrahamsson
- Department of Pediatrics, Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsi Jahnukainen
- Division of Pediatric Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland
| | - Mats Heyman
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
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Gruber TA, Zwaan CM. Central nervous system disease in pediatric acute myeloid leukemia. Pediatr Blood Cancer 2017; 64. [PMID: 28853216 DOI: 10.1002/pbc.26782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/02/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Tanja A Gruber
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - C Michel Zwaan
- Erasmus MC-Sophia, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Støve HK, Sandahl JD, Abrahamsson J, Asdahl PH, Forestier E, Ha SY, Jahnukainen K, Jónsson ÓG, Lausen B, Palle J, Zeller B, Hasle H. Extramedullary leukemia in children with acute myeloid leukemia: A population-based cohort study from the Nordic Society of Pediatric Hematology and Oncology (NOPHO). Pediatr Blood Cancer 2017; 64. [PMID: 28333413 DOI: 10.1002/pbc.26520] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 01/16/2017] [Accepted: 02/10/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prognostic significance of extramedullary leukemia (EML) in childhood acute myeloid leukemia is not clarified. PROCEDURE This population-based study included 315 children from the NOPHO-AML 2004 trial. RESULTS At diagnosis, 73 (23%) patients had EML: 39 (12%) had myeloid sarcoma, 22 (7%) had central nervous system disease, and 12 (4%) had both. EML was associated with young age (median age: 2.6 years), a high white blood cell count (median: 40 × 109 /l), M5 morphology (40%), and 11q23/MLL (KMT2A) rearrangements (34%). No patient received involved field radiotherapy. Five-year event-free survival did not differ significantly between the EML and the non-EML patients (54% vs. 45%, P = 0.57), whereas 5-year overall survival (OS) was significantly lower in the EML group (64% vs. 73%, P = 0.04). The risk of induction death was significantly higher for EML patients (8% vs. 1%, P = 0.002). There was a trend toward a lower risk of relapse for EML patients (5-year cumulative incidence of relapse 33% vs. 49%, P = 0.16). Traumatic lumbar puncture did not adversely affect survival in this cohort. CONCLUSIONS EML was associated with increased risk of induction death impacting the OS. No patients relapsed at the primary site of the myeloid sarcoma despite management without radiotherapy.
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Affiliation(s)
| | | | - Jonas Abrahamsson
- Department of Pediatrics, Institution for Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Peter H Asdahl
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Forestier
- Department of Medical Biosciences and Genetics, Umeå University Hospital, Umeå, Sweden
| | - Shau-Yin Ha
- Department of Pediatrics, Hong Kong Pediatric Hematology & Oncology Study Group, Queen Mary Hospital, Hong Kong, China
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Josefine Palle
- Department of Woman's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Bernward Zeller
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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Totadri S, Bhatia P, Sreedharanunni S. RUNX1-RUNX1T1-positive acute myeloid leukaemia presenting as bilateral proptosis and multiple cranial nerve palsy. BMJ Case Rep 2017; 2017:bcr-2017-221402. [PMID: 28993357 DOI: 10.1136/bcr-2017-221402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a unique presentation of acute myeloid leukaemia (AML) with myeloid sarcoma (MS), manifested as proptosis with multiple cranial nerve palsies in a 9-year-old boy. MRI of the brain revealed multiple enhancing lesions and bilateral mastoiditis, in addition to sagittal sinus thrombosis. Peripheral blood smear demonstrated blasts showing Auer rods. Bone marrow examination confirmed the diagnosis of AML. PCR was positive for RUNX1-RUNX1T1. Neurological deficits improved with induction chemotherapy for AML. Extramedullary MS can present simultaneously with or antedate AML. Common genetic aberrations include t(8;21) and inv(16). Therapy is akin to AML. An effect of MS on survival outcomes is variable.
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Affiliation(s)
- Sidharth Totadri
- Department of Pediatric Hematology Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Prateek Bhatia
- Department of Pediatric Hematology Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Sreejesh Sreedharanunni
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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Angsubhakorn N, Suvannasankha A. Multifocal myeloid sarcomas: a rare presentation of AML. BMJ Case Rep 2017; 2017:bcr-2017-222659. [PMID: 28978612 DOI: 10.1136/bcr-2017-222659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Natthapon Angsubhakorn
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Attaya Suvannasankha
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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40
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Arber DA, Borowitz MJ, Cessna M, Etzell J, Foucar K, Hasserjian RP, Rizzo JD, Theil K, Wang SA, Smith AT, Rumble RB, Thomas NE, Vardiman JW. Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med 2017; 141:1342-1393. [PMID: 28225303 DOI: 10.5858/arpa.2016-0504-cp] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - A complete diagnosis of acute leukemia requires knowledge of clinical information combined with morphologic evaluation, immunophenotyping and karyotype analysis, and often, molecular genetic testing. Although many aspects of the workup for acute leukemia are well accepted, few guidelines have addressed the different aspects of the diagnostic evaluation of samples from patients suspected to have acute leukemia. OBJECTIVE - To develop a guideline for treating physicians and pathologists involved in the diagnostic and prognostic evaluation of new acute leukemia samples, including acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage. DESIGN - The College of American Pathologists and the American Society of Hematology convened a panel of experts in hematology and hematopathology to develop recommendations. A systematic evidence review was conducted to address 6 key questions. Recommendations were derived from strength of evidence, feedback received during the public comment period, and expert panel consensus. RESULTS - Twenty-seven guideline statements were established, which ranged from recommendations on what clinical and laboratory information should be available as part of the diagnostic and prognostic evaluation of acute leukemia samples to what types of testing should be performed routinely, with recommendations on where such testing should be performed and how the results should be reported. CONCLUSIONS - The guideline provides a framework for the multiple steps, including laboratory testing, in the evaluation of acute leukemia samples. Some aspects of the guideline, especially molecular genetic testing in acute leukemia, are rapidly changing with new supportive literature, which will require on-going updates for the guideline to remain relevant.
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41
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Cuglievan B, Menegaz BA, Garces S, Rytting ME. Acute myeloid leukaemia masquerading as a primary CNS tumour. BMJ Case Rep 2017; 2017:bcr-2017-220891. [DOI: 10.1136/bcr-2017-220891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sato Y, Koyama S, Kuwashima S, Kato M, Okuya M, Fukushima K, Kurosawa H, Arisaka O. Central hypothyroidism in a pediatric case of primary acute monoblastic leukemia with central nervous system infiltration: A case report. Medicine (Baltimore) 2017; 96:e7329. [PMID: 28658145 PMCID: PMC5500067 DOI: 10.1097/md.0000000000007329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Central nervous system (CNS) leukemia is a frequent diagnosis in pediatric acute myeloblastic leukemia (AML) and includes neural symptoms. However, CNS leukemia is rarely associated with central hypsothyroidism. PATIENT CONCERNS AND DIAGNOSES A 2-year-old female with AML with MLL rearrangement presented with CNS infiltration. Laboratory tests suggested the presence of central hypothyroidism (thyroid-stimulating hormone [TSH]: 0.48 mIU/ml, normal range 0.7-6.4 mIU/ml; serum free thyroxine [FT4]: 0.62 ng/dl, normal range 0.8-2.2 ng/dl; free triiodothyronine: 1.57 pg/ml, normal range 2.7-5.6 pg/ml). Magnetic resonance imaging detected no lesions in the hypothalamus, pituitary, or thyroid. INTERVENTIONS AND OUTCOMES Levothyroxine (2.5 mg/kg/day) was administered together with chemotherapy and intrathecal injection of methotrexate, cytarabine, and hydrocortisone into the cerebrospinal fluid. The FT4 concentration increased after levothyroxine treatment, but later decreased after relapse of CNS leukemia. The TSH concentrations remained low. After remission of CNS leukemia, the TSH and FT4 concentrations quickly recovered to their normal ranges. LESSONS We believe that the CNS leukemia directly affected TSH and thyroid hormone secretion in our patient.
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MESH Headings
- Central Nervous System Neoplasms/complications
- Central Nervous System Neoplasms/diagnostic imaging
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/metabolism
- Child, Preschool
- Diagnosis, Differential
- Female
- Humans
- Hypothyroidism/complications
- Hypothyroidism/diagnostic imaging
- Hypothyroidism/drug therapy
- Leukemia, Monocytic, Acute/complications
- Leukemia, Monocytic, Acute/diagnostic imaging
- Leukemia, Monocytic, Acute/drug therapy
- Leukemia, Monocytic, Acute/pathology
- Thyrotropin/blood
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Affiliation(s)
| | | | - Shigeko Kuwashima
- Department of Radiology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
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Yoon HM, Kim JR, Jung AY, Cho YA, Im HJ, Lee JS. Whole Body MR Imaging: A Useful Imaging Modality in the Management of Children With Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:231-237. [PMID: 28284743 DOI: 10.1016/j.clml.2017.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/24/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION To evaluate the distribution of chloromas using whole body magnetic resonance (MR) imaging in pediatric patients with acute myeloid leukemia (AML) and to assess the clinical role of whole body MR imaging in management of pediatric patients with AML. MATERIALS AND METHODS We retrospectively searched pediatric patients (< 18 years old) who were diagnosed with AML and underwent whole body MR imaging during their illness between January 2006 and December 2014. The presence of chloromas was defined as when it was proven pathologically or showed typical imaging features. Nonchloroma lesions that were incidentally detected and were not previously seen on other imaging studies were defined as clinically occult nonchloroma lesions. RESULTS Sixty-nine whole body MR scans of 40 patients with AML were included. The musculoskeletal system (42.9%) was the most commonly affected by chloromas. A total of 77 chloromas were identified in 11 (27.5%) of 40 patients. Nine (81.8%) of these 11 patients had 2 or more chloromas. There were 39 (50.6%) unexpected chloromas, which were incidentally detected, in 7 patients. Whole body MR scanning provided additional information regarding 21 clinically occult nonchloroma lesions in this patient population. CONCLUSION Chloromas tended to show multiplicity and be present without symptoms. The most common site of involvement was the musculoskeletal system. Whole body MR imaging provided additional information that affected the clinical management of children with AML.
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Affiliation(s)
- Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Rye Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Myeloid sarcoma in children - diagnostic and therapeutic difficulties. Contemp Oncol (Pozn) 2017; 20:444-448. [PMID: 28239280 PMCID: PMC5320455 DOI: 10.5114/wo.2016.65602] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/24/2015] [Indexed: 12/15/2022] Open
Abstract
Myeloid sarcoma (MS) is a malignant extramedullary tumour, which consists of immature cells of myeloid origin. It may occur de novo, concurrently or precede the diagnosis of acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) or chronic myeloid leukemia (CML). MS can also be a manifestation of the relapse of the disease. The more frequent sites of involvement are the skin, orbit, bone, periosteum, lymph nodes, gastrointestinal tract, soft tissue, central nervous system and testis. Because of its different localization and symptoms, and the lack of diagnostics algorithm, myeloid sarcoma is a real diagnostic challenge, in particular in patients without initial bone marrow involvement. The correct diagnosis of MS is important for adequate therapy, which is often delayed because of a high misdiagnosis rate. In the paper, the role of immunohistochemistry, cytogenetic and molecular genetic analyses is emphasized as well as the breadth of unclear aspects of this disorder in children.
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Pathy S, Venkatesulu BP, Mallick S, Chander S. Radiation Therapy in Paediatric Orbital Granulocytic Sarcomas: Experience from a Tertiary Cancer Center. J Clin Diagn Res 2016; 10:XC01-XC05. [PMID: 27891440 DOI: 10.7860/jcdr/2016/19773.8599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Orbital Granulocytic Sarcoma (OGS) is an uncommon manifestation associated with haematological malignancies. Chemotherapy remains the cornerstone of the treatment. The role of radiation is not well-defined. AIM To evaluate the effect of radiation in OGS and to define an optimal dose for achieving adequate local control. MATERIALS AND METHODS This was a retrospective analysis of 11 patients who received radiation therapy to orbit for Granulocytic Sarcoma (GS) between 2007 and 2014 at a tertiary cancer center in India. Radiotherapy was planned by three dimensional conformal (3DCRT) techniques. Demographic and disease characteristics, including clinical, imaging, histopathology and treatment details in this patient cohort were recorded and their response to therapy was assessed. RESULTS The median age was 7 years (Range: 2-16 years). There were 3 female and 8 male patients. Eight patients were diagnosed as Acute Myelogenous Leukemia (AML), two patients had Primary Orbital Granulocytic Sarcoma (POGS) and one had bi-phenotypic leukemia. Median dose was 24.5Gy (Range-15-45 Gy). Two anterior oblique field design were used most commonly. Out of 11 patients, 5 (45.4%) had complete response, 3 (27.27%) had partial response, 1 patient had stable disease (9%) and 2 developed progressive disease (18%). Median follow-up was 24 months (Range 24-84 months). At last follow-up, 7 (63.6%) patients were alive and 4 patients (37.4%) were dead due to progressive disease. CONCLUSION In patients with residual orbital disease after chemotherapy, low dose radiation can be used to improve local disease control and improve quality of life. Local conformal radiotherapy of 24-30 Gy in conventional fractionation appears optimal with excellent local control and minimal morbidity.
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Affiliation(s)
- Sushmita Pathy
- Additional Professor, Department of Radiation Oncology, All India Institute of Medical Sciences , New Delhi, India
| | - Bhanu Prasad Venkatesulu
- Senior Resident, Department of Radiation Oncology, All India Institute of Medical Sciences , New Delhi, India
| | - Supriya Mallick
- Senior Research Associate, Department of Radiation Oncology, All India Institute of Medical Sciences , New Delhi, India
| | - Subhash Chander
- Professor, Department of Radiation Oncology, All India Institute of Medical Sciences , New Delh, India
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Abstract
Acute erythroid leukemia is rare, with isolated reports on presentation as an extramedullary tumor mass (myeloid sarcoma). We describe a case of pure erythroid leukemia presenting as an orbital mass in a 1-year, 9-month-old girl. This is only the second case described in a child. Tissue biopsy of the tumor mass showed medium-sized cells that were glycophorin A positive and negative with conventional myeloid markers. Flow cytometry, bone marrow aspirate, and trephine confirmed the diagnosis of pure erythroid leukemia.
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Grigalunas AL, Mizen TR. Myeloid sarcoma of the orbit without systemic recurrence of disease in an adult: A clinicopathological case report. Orbit 2016; 35:106-8. [PMID: 26905183 DOI: 10.3109/01676830.2015.1099704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Myeloid sarcoma (MS), also known as granulocytic sarcoma (GS) or chloroma (named for the greenish hue attributed to the pigment of myeloperoxidase [MPO]), is a rare solid tumor with a predilection for the orbit. MS usually occurs in conjunction with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or myeloproliferative disorder (MPS) and may be the harbinger of disease. Therefore, prompt diagnosis is essential for patient survival. We present a rare case of a 61 year old with an isolated orbital MS without active leukemia.
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Affiliation(s)
- Alexander L Grigalunas
- a Rush University Medical Center , Department of Ophthalmology , Chicago , Illinois , USA
| | - Thomas R Mizen
- a Rush University Medical Center , Department of Ophthalmology , Chicago , Illinois , USA
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Qualitative Assessment of Diffusion Weighted Imaging and Susceptibility Weighted Imaging of Myeloid Sarcoma Involving the Brain. J Comput Assist Tomogr 2016; 40:61-6. [DOI: 10.1097/rct.0000000000000337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES This session of the 2013 Society of Hematopathology/European Association for Haematopathology workshop focused on extramedullary manifestations of myeloid neoplasms. METHODS We divided the submitted cases into four subgroups: (1) isolated myeloid sarcoma (MS); (2) MS with concurrent acute myeloid leukemia (AML), with a focus on karyotypic and molecular findings; (3) extramedullary relapse of AML, including relapse in the posttransplant setting; and (4) blast phase/transformation of a myeloproliferative neoplasm or chronic myelomonocytic leukemia. RESULTS Establishing a diagnosis of isolated MS requires a high index of suspicion and use of immunophenotypic methods. Recurrent cytogenetic abnormalities or gene mutations that occur in MS mirror those known to occur in AML. CONCLUSIONS In the era of targeted therapy and sophisticated risk stratification, every attempt must be made to perform a complete workup on MS cases (or concurrent AML) since the diagnosis of MS, in itself, is no longer adequate for patient management. Cases of blastic plasmacytoid dendritic cell neoplasm were also included and discussed in this session.
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Affiliation(s)
- Carla S. Wilson
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque
| | - L. Jeffrey Medeiros
- The Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston
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Lee JW, Cho B. Diagnosis and Treatment of Pediatric Acute Myeloid Leukemia. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2015. [DOI: 10.15264/cpho.2015.22.1.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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