Clinical significance of granulocytic sarcoma in adult patients with acute myeloid leukemia

Abstract

To investigate the clinical significance of granulocytic sarcoma (GS) in adults with acute myeloid leukemia (AML), 434 consecutive patients with AML were analyzed retrospectively. Forty-five patients (10.4%) with GS at diagnosis were younger (P < 0.001), presented with higher white blood cell counts (P = 0.03) and were more likely to conform to French-American-British M4 (P = 0.001) and M5 (P = 0.045) classifications than those without GS. In contrast, no significant difference in frequency of cytogenetic abnormalities was found between the GS and non-GS groups. Treatment outcomes in 260 patients (40 with GS) who underwent intensive chemotherapy, excluding patients with acute promyelocytic leukemia, were investigated. Complete remission rates did not differ significantly between the GS and non-GS groups (75.0% vs 79.1%; P = 0.192, respectively) or the 5-year overall survival (OS) rates (39.9% vs 38.7%; P = 0.749, respectively). However, the GS group had a significantly higher relapse rate than the non-GS group (74.2% vs 55.3%; P = 0.048) and a significantly lower 5-year disease-free survival rate (8.2% vs 25.7%, respectively; P = 0.005). When considered together with the results of multivariate analysis, which identified the presence of GS as an independent predictor for disease-free survival time, these findings indicate that GS might identify a high-risk subset of patients with AML. (Cancer Sci 2012; 103: 1513-1517 G ranulocytic sarcoma (GS), a rare extramedullary tumor composed of malignant granulocytic precursor cells that affects 3-9% of patients diagnosed with acute myeloid leukemia (AML), (1)(2)(3) occurs concomitantly with or after a diagnosis of AML. Granulocytic sarcoma can occur in any organ and common sites are bones, lymph nodes, soft tissues and skin. (4) Other organs, including the brain, (5,6) orbit (7,8) and genitourinary system, (9,10) are infrequently affected by GS. Such variation in its site of occurrence complicates accurate diagnosis of GS, and, moreover, the low incidence of GS has impeded establishment of the clinical characteristics of patients with GS. Several studies have reported that specific factors, including French-American-British (FAB) M4 and M5 classification (11,12) and the expression of CD56 (13,14) or T-cell antigens (CD2, CD4 and CD7) (15,16) on leukemia cells, are associated with GS, while others have identified an association between GS and t(8;21) (17,18) or inv(16). (19,20) Establishment of the clinical characteristics of GS has been further impeded by the mixed results obtained by several studies that investigated the prognosis of GS in limited subpopulations of AML patients. Byrd et al. (21) found that GS was associated with unfavorable outcomes and a shorter survival time (median 5.4 months with GS vs 59.5 months without GS) among AML patients carrying t(8;21), whereas Felice et al. (22) argued that GS had no adverse prognostic impact on AML patients carrying t(8;21). In light of these discrepant findings, this study aimed to clarify the clinical significance of GS...

Allogeneic hematopoietic stem cell transplantation for adult AML patients with granulocytic sarcoma

“…Furthermore, GS was associated with higher relapse rate and lower disease-free survival. 4 As several investigators have previously reported, these findings indicate that GS is one of the features of high-risk disease in adult AML. 5,6 However, the optimal therapeutic strategy for GS remains unclear, especially in regards to the indications for need of allogeneic hematopoietic stem cell transplantation (allo-HSCT).…”

“…GS group was significantly younger and had higher white blood cell counts compared with non-GS group as our previous report. 4 Clinical characteristics of the GS group In 44 patients with GS, the most frequently site of GS was the lymph nodes. GS occurred at two distinct sites concomitantly in six patients.…”

Myeloid sarcoma derived from the gastrointestinal tract: A case report and review of the literature

“…There are four clinical presentations of myeloid sarcoma (5): i) Accompanied with acute myeloid leukemia (AML); ii) could be the portent of AML; iii) could be associated with myelodysplastic disease transforming to leukemia; and iv) solitary tumors. However, such localized primitive granulocytic sarcomas are extremely rare and they could develop to AML if no treatment is provided (5). The case in the current study presented as multiple solitary tumors and the routine bone marrow examination was normal.…”

Acute Myeloid Leukemia Concurrent with Spinal Epidural Extramedullary Myeloid Sarcoma Accompanied by a High CD25 Expression and the <i>FLT3-ITD</i> Mutation

“…It occurs in from 3-9% of patients with acute myeloid leukemia (AML) (1,2). MS usually occurs concomitantly with or after the diagnosis of AML (3)(4)(5). It may also present antedating the onset of systemic bone marrow leukemia (6,7), and many such cases are misdiagnosed as lymphoma (8).…”