Multiple extramedullary relapses without bone marrow involvement after second allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia

Yoo, Sang Woo; Chung, Eun Jin; Kim, Sun Young; Ko, Jeong Hee; Baek, Heysung; Lee, Hyun Ju; Oh, Sung Hee; Jeon, Seok Cheol; Lee, Woong Soo; Park, Chan Kum; Lee, Chul Hoon

doi:10.1111/j.1399-3046.2011.01546.x

Cited by 20 publications

(11 citation statements)

References 14 publications

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“…In 15-35% of cases, MS can appear concomitantly with AML, whereas, in 50% of cases MS appears following the diagnosis of AML. In rare instances (<1%), MS has also been diagnosed after allogenic stem cell transplantation (allo-SCT), which manifests as an isolated tumor with or without accompanying blood and bone marrow relapse [14,15].…”

Section: Epidemiologymentioning

confidence: 99%

Myeloid Sarcoma: The Other Side of Acute Leukemia

Kahali¹

2018

Hematology - Latest Research and Clinical Advances

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Myeloid sarcomas are extramedullary myeloid masses with associated tissue damage. Myeloid sarcomas usually arise before, during or after diagnosis of acute leukemia, most often AML. Majority of the patients with myeloid sarcoma respond to upfront systemic chemotherapy and sometimes bone marrow transplant, but it is unclear which patients will benefit from which treatments. This is primarily due to the paucity of knowledge on myeloid sarcoma. At present, there are no prognostic biomarkers for myeloid sarcoma, which can help in risk stratification in patients with myeloid sarcoma. Several studies have suggested that myeloid sarcoma is more likely to occur with certain translocations such as CBF and MLL rearrangements. In addition, sequencing analysis has identified several mutations in genes such as FLT3, NPM1, EZH2, and KIT. Nevertheless, there is still lack of knowledge to understand why particular leukemia migrates to the skin and soft tissues and becomes refractory to systemic therapy.

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Section: Epidemiologymentioning

confidence: 99%

Myeloid Sarcoma: The Other Side of Acute Leukemia

Kahali¹

2018

Hematology - Latest Research and Clinical Advances

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“…Extramedullary relapse is an important complication, which is more frequent in post-transplant patients compared with patients treated without alloHSCT. Its incidence is about 7–46% of all AML relapses [ 18 ]. It may occur with or without bone marrow involvement, but isolated extramedullary relapse rarely occurs; in children it is limited to case reports [ 4 , 18 ].…”

Section: Clinical Manifestation Of Myeloid Sarcomamentioning

confidence: 99%

Myeloid sarcoma in children – diagnostic and therapeutic difficulties

Samborska¹,

Derwich²,

Skalska‐Sadowska³

et al. 2016

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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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“…Thus, the diagnosis of an EM relapse is often delayed until patients develop the symptoms of a large mass, such as abdominal pain or constipation. However, a number of recent reports have shown that EM infiltration of AML can be detected by 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) or FDG-PET/computed tomography (CT) [43][44][45][46][47][48][49][50][51][52][53]. St€ olzel et al [54] recently reported the results of FDG-PET/CT in 10 patients with AML with histologically proven EM disease at diagnosis (n 5 5), relapse after alloSCT (n 5 4), or relapse after chemotherapy (n 5 1).…”

Section: Diagnostic Modalitiesmentioning

confidence: 99%

Extramedullary Relapse of Acute Myeloid Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation: An Easily Overlooked but Significant Pattern of Relapse

Yoshihara

Ando

Ogawa

2012

Biology of Blood and Marrow Transplantation

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Acute myeloid leukemia may manifest as myeloid sarcoma in a variety of extramedullary (EM) tissues at diagnosis or at relapse. Although EM relapse after allogeneic hematopoietic stem cell transplantation (alloSCT) has been considered to be rare, recent studies have suggested that it occurs in 5% to 12% of patients who receive alloSCT, accounting for 7% to 46% of total relapses. The incidence of EM relapse after immunomodulation (eg, donor lymphocyte infusion) or a second SCT is even higher. Moreover, patients with EM relapse are more likely to have had preceding acute graft-versus-host disease or chronic graft-versus-host disease relative to those with bone marrow relapse. Collectively, these observations suggest that the preferential occurrence of the graft-versus-leukemia effect underlies the pathogenesis of EM relapse. Establishing an early diagnosis of EM relapse has been challenging because of the immense diversity in the relapse sites; however, recent studies have suggested the usefulness of (18)F-fluorodeoxyglucose positron emission tomography scans in the detection of EM relapse. As a treatment for EM relapse, a combination of local and systemic therapy should be considered, because local therapy alone often results in subsequent systemic relapse. The prognosis for patients who develop EM relapse after SCT remains poor but is slightly better than that after bone marrow relapse. In addition to an early diagnosis with new modalities, clinical studies using new agents that may offer systemic activity while preserving the graft-versus-leukemia effect are warranted as part of an effort to improve the clinical outcome.

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Multiple extramedullary relapses without bone marrow involvement after second allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia

Cited by 20 publications

References 14 publications

Myeloid Sarcoma: The Other Side of Acute Leukemia

Myeloid Sarcoma: The Other Side of Acute Leukemia

Myeloid sarcoma in children – diagnostic and therapeutic difficulties

Extramedullary Relapse of Acute Myeloid Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation: An Easily Overlooked but Significant Pattern of Relapse

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