Isolated Breast Relapse of Acute Lymphoblastic Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation

Demırsoy, Esra Terzı; Atesoglu, Elif Birtas; Tarkun, Pınar; Gedük, Ayfer; Erdem, Büşra Erşan; Hacıhanefioğlu, Abdullah; Erçin, Mehmet Cengiz

doi:10.1007/s12288-015-0560-z

Cited by 3 publications

(3 citation statements)

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“…Two patients remained clinically well at 1 and 2 years , two had further tumors , and one had no follow‐up information . Two others patients, who did not have marrow relapse, received chemotherapy only; one died on treatment and the other is well over 4 years after second transplant . Of four patients who received combination therapy, three obtained remissions.…”

Section: Resultsmentioning

confidence: 98%

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Cunningham

Kohno

2016

American J Hematol

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Extramedullary tumors remain an obstacle to curing more acute leukemia patients. Their incidence is unknown because the presence of occult tumors that contribute to relapse is not routinely sought as in other cancers. No standard approach exists for treating tumors at most sites, apparent clinical response is typically followed by further tumors, and achievement of lengthy remission is uncommon. Body scanning with 18 FDG PET/CT now provides a means to identify the extent of occult tumors that enables directed tumor eradication and a way to evaluate tumor response. To evaluate its potential benefits, analysis was undertaken of 124 published cases scanned after apparent tumors were diagnosed. Clinical and radiologic exams underestimated extent of disease in over half of 100 cases. Among 70 cases that reported scans after various treatments, 70% achieved negative scans. Half relapsed subsequently but disease-free survivals up to 6 years were documented. These reported cases add to our knowledge of extramedullary leukemia in showing that further tumors are more likely than marrow relapse, clinical and radiologic evaluation of response is inadequate, intensive chemotherapy alone generally does not prevent progression and is associated with significant mortality, and tumor-directed plus systemic therapies appears the most effective approach, particularly to AML tumors. This analysis suggests this technology could increase our ability to eradicate all foci of leukemia, and identify tumors responsible for refractory, residual, and relapsed disease.

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Section: Resultsmentioning

confidence: 98%

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Cunningham

Kohno

2016

American J Hematol

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“…Acute myeloid leukemia constitutes the most common type of acute leukemia in adults, and is also the most common type infiltrating the breasts. Isolated extramedullary relapse of T-cell acute lymphoblastic leukemia (T-ALL) within the breast is exceedingly rare and there is paucity of data in the literature regarding this entity[5-7]. No consensus exists on management of isolated extramedullary breast relapses of T-ALL.…”

Section: Introductionmentioning

confidence: 99%

Breathing adapted radiation therapy for leukemia relapse in the breast: A case report

Sager¹,

Dincoglan²,

Demiral³

et al. 2019

WJCO

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BACKGROUNDInfiltration of the breast by leukemic cells is uncommon but may manifest as an oncological emergency requiring prompt management. Extramedullary relapse of T-cell acute lymphoblastic leukemia (T-ALL) within the breast is exceedingly rare and there is paucity of data in the literature regarding this entity. No consensus exists on management of isolated extramedullary breast relapses of T-ALL. Herein, we report a case of isolated extramedullary breast relapse of T-ALL treated with breathing adapted radiation therapy (BART) using the active breathing control (ABC) system.CASE SUMMARYThe patient was a 33-year-old female with diagnosis of T-ALL. She received intensive systemic chemotherapy that resulted in complete remission of her disease, and then underwent allogeneic hematopoietic stem cell transplantation. After a 15 mo period without symptoms and signs of progression, the patient presented with palpable masses in both breasts. She complained from severe pain and swelling of the breasts. Imaging workup showed bilateral breast lesions, and diagnosis of breast infiltration by leukemic cells was confirmed after immunohistopathological evaluation. The patient suffering from severe pain, discomfort, and swelling of both breasts due to leukemic infiltration was referred to the Radiation Oncology Department for symptomatic palliation. Whole breast irradiation was delivered to both breasts of the patient with BART using the ABC system. The patient had complete resolution of her symptoms after treatment with BART.CONCLUSIONBART with the ABC system resulted in complete resolution of the patient’s symptoms due to leukemic infiltration of both breasts with T-ALL. This contemporary treatment technique should be preferred for radiotherapeutic management of patients with leukemic infiltration of the breasts to achieve effective symptomatic palliation.

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“…A serious issue is associated with development of extramedullary relapses which are underdiagnosed because they can manifest with no detectable MRD and in FDC state in the presence of GVHD, even in relapse burden [56,63]. Th ere is also a risk to miss early signs of relapse, if the monitoring intervals for the marrow chimerism and MRD exceed 2 months.…”

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confidence: 99%

Minimal residual disease monitoring by RQPCR of Ig/TCR rearrangements: an effective method to predict relapse in children with acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation

Лавриненко¹,

Meleshko²,

Lutskovich³

et al. 2018

CTT

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At the present time, clinical relapses remain the major cause of treatment failure in children with acute lymphoblastic leukemia (ALL) treated by allogeneic hematopoietic stem cell transplantation (allo-HSCT). So far, the requirements for precise quantifi cation of minimal residual disease (MRD) aft er HSCT were did not confi rmed. Th e aim of this study was to evaluate the impact of MRD assays on management and prediction of outcomes aft er allo-HSCT. Patients and methods Th e Ig/TCR markers were identifi ed for MRD monitoring in 37 (82.2%) of 45 patients. Presence of high-level MRD aft er allo-HSCT was an unfavorable prognostic factor for the clinical outcome. Th e 3-year cumulative incidence (CI) of relapse in the patients with negative MRD vs MRD levels of ≤10-3 , and >10-3 proved to be 10.7±7.4%; 14.6±14.6%, and 100%, respectively (p<0.0001). Event-free survival (EFS) was 66.6±11.4% vs 43.8±18.8% vs 0% (p=0.0012) at the respective MRD levels, whereas overall survival (OS) was 83.6±8.8% vs 57.1±18.7% vs 0% (p=0.0083), resp., for undetectable, ≤10-3 , and >10-3 MRD levels. MRD positivity combined with increasing mixed chimerism (MC) was followed by relapse in almost all cases. MRD clearance was more oft en observed in patients with full donor chimerism (FDC) having graft-versus-host disease (GvHD) posttransplant, or aft er donor lymphocyte infusion. Conclusion Positive MRD aft er HSCT is an unfavorable factor for OS and EFS, being associated with ALL re-occurrence. We identifi ed the high-risk group for relapses aft er allo-HSCT among ALL patients, i.e., those cases which showed MRD positivity with mixed chimerism (MC) and absence of GvHD, and/or had MRD>10-3 .

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Isolated Breast Relapse of Acute Lymphoblastic Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 3 publications

References 14 publications

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Breathing adapted radiation therapy for leukemia relapse in the breast: A case report

Minimal residual disease monitoring by RQPCR of Ig/TCR rearrangements: an effective method to predict relapse in children with acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation

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Isolated Breast Relapse of Acute Lymphoblastic Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 3 publications

References 14 publications

18FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

18FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Breathing adapted radiation therapy for leukemia relapse in the breast: A case report

Minimal residual disease monitoring by RQPCR of Ig/TCR rearrangements: an effective method to predict relapse in children with acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation

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¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases