Granulocytic sarcoma and subsequent acute leukemia recurrence with different biologic characteristics 5 years after allogeneic bone marrow transplantation for acute myeloid leukemia

Post-transplant leukemia relapse in organs: biology. and behavior in 585 reports

Resistance of extramedullary leukemia growth post-transplant prevents cure. Review of its behavior detailed in 585 published cases should lead to better treatment. Leukemic tumors were found up to 13 years after transplant, most in sites inaccessible to physical exam. In 83%, marrow was not in morphologic relapse; next relapse was most often extramedullary. Induction protocols alone produced few durable responses in acute leukemias and fatal marrow aplasia in 17 %. Overall, 120 patients survived over 2 years, 43 relapse-free up to 18 years, the majority after combined tumor-directed and systemic therapy. Overall median survival was 9 months. This review highlights how results can improve: by defining extent of leukemia involvement with scans before transplant, and emergently when leukemic tumor is found after, ablating tumor directly to abort metastasis, and determining dosing of systemic chemotherapy that protects, without ablating, donor marrow. Monitoring total body remission with body scans should increase transplant cures.

Clinical and pathologic analysis of extramedullary tumors after hematopoietic stem cell transplantation

Clinical and pathologic analyses of 41 extramedullary biopsy/resection specimens of extramedullary tumors (EMTs) after hematopoietic stem cell transplantation (HSCT) were performed. The 41 EMT specimens were from 28 patients, with 11 having more than 1 consecutive EMT in different anatomic locations at different times post-HSCT. The median age at EMT diagnosis was 45 years (range, 17-73 years), and the male/female ratio was 17:11. The most common initial diagnosis was acute myeloid leukemia (21), followed by chronic myeloid leukemia with myeloid blast phase (2), primary myelofibrosis with acute leukemic transformation (1), acute lymphoblastic leukemia (2), mixed lineage T/myeloid leukemia (1), and plasma cell myeloma (1). All initial presentations were limited to bone marrow-only disease. Twenty patients had abnormal chromosomal karyotypes, whereas 6 had normal cytogenetics with their original disease. All patients received standard chemotherapy followed by allogeneic (27) or autologous (1) HSCT. The EMTs occurred 2 to 177 months (median, 16.5 months) after HSCT and were diagnosed as solid mass lesions as follows: skin and soft tissue (10), central nervous system and paraspinal tissue (9), breast (7), gastrointestinal tract (4), lymph node (4), genitourinary system (4), and mediastinum (3). Interestingly, all but 3 patients had negative bone marrows at the time their EMT was diagnosed, indicating that most EMTs presented as sole lesion of relapsed disease. The overall outcome was dismal for patients with EMT, with 20 (71%) of 28 patients deceased at 1 to 26 months after EMT diagnosis, with a median overall survival of only 6.5 months.

Clinicopathologic features and responses to radiotherapy of myeloid sarcoma

Background

To evaluate clinicopathological features, radiotherapeutic parameters, and their associations with responses to radiotherapy (RT) in patients with myeloid sarcoma (MS).

Methods

We reviewed 20 patients receiving RT for MS lesions (in 43 RT courses) and analyzed the patients’ clinicopathologic features and radiotherapeutic parameters, and their associations with complete responses (CR) to RT using Fisher’s exact test and univariate logistic regression analysis. Generalized Estimating Equation was used to analyze all 43 irradiated lesions and account for the correlations in RT responses among lesions from the same patient.

Results

We found that the underlying hematological diseases of the evaluated patients were acute myeloid leukemia (AML) in 14 patients (70%), chronic myeloid leukemia in 4 patients (20%), myelodysplastic syndrome with AML transformation in one patient (5%), and de novo MS in one patient (5%). Most patients (55%) received RT for MS at the time of relapse following bone marrow transplantation (BMT). The most common cytogenetic abnormality was t(8;21)(q22;q22). The median RT dose of 20 Gy (range 6–35 Gy), administered in 1.5-3.5 Gy fractions, provided a 63% CR rate. RT dose, sex, cytogenetics, and bone marrow status at the time of RT had no significant effect on CR. Younger age (<50 y, P = 0.06), BMT prior to RT (P = 0.05), and underlying AML (P = 0.05) were marginally associated with higher CR to RT.

Conclusions

Our results indicate that a modest RT dose (20-30 Gy) achieves good local control of MS. Age, previous BMT, and underlying hematologic disease can affect RT response.

Chloroma of pancreas-initial manifestation of a secondary leukemia after stem cell transplantation case report and review of the literature

INTRODUCTION

Chloroma is an extramedullary solid tumor consisting of immature myeloid cells.

CASE PRESENTATION

We report a patient with painless jaundice 6 years after allogeneic peripheral stem cell transplantation because of an acute myeloid leukemia leading us to the diagnosis of a chloroma of the pancreas as the first manifestation of a secondary host leukemia.

DISCUSSION

A histological examination of unclear pancreatic tumors should be mandatory in patients with a history of leukemia. If surgical therapy is unavoidable because of stenosis symptoms or for histological proof, a resection should be avoided.

CONCLUSION

Bypass surgery can ease the symptoms and it allows timely curative chemotherapy or stem cell transplantation.

A case of donor-derived granulocytic sarcoma after allogeneic hematopoietic stem cell transplantation

The occurrence of granulocytic sarcoma as a pattern of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. In this paper, we report a rare case of acute myeloid leukemia (AML) relapsed as a granulocytic sarcoma of the donor type. The patient was diagnosed as having AML and underwent an allo-HSCT from his matched sibling donor. Fifty-seven months after allo-HSCT, he developed granulocytic sarcomas of duodenum, jejunum, and left sterno-cleido-mastoid muscle. The bone marrow was normal with 100% donor chimerism. A Y chromosome PCR was performed on the patient's duodenum specimen as well as bone marrow aspirate in order to check the patient-origin cells. The duodenal specimen was found to contain 41.2% SRY-positive cells (from the donor). Repeat endoscopy on day 2 of chemotherapy showed that the granulocytic sarcoma had shrunk dramatically. The patient died of sepsis during the nadir state 35 days after starting salvage chemotherapy.