Myeloid sarcoma: experience from a hematology care centre of Eastern India

Abstract

Objectives: To describe the case series of patients with myeloid sarcoma with their clinicopathological characteristics, cytogenetics, molecular markers, prognosis, and outcome. Material and Methods: Retrospective retrieval of data of myeloid sarcoma cases in acute myeloid leukemia was done from the electronic health records of our hospital and this case series includes the data of three years starting from January 2018 and the follow-up information was assimilated until December 2020. Results: We present twelve patients in this case series with myeloid sarcoma and all these patients had bone marrow involvement at presentation. Most of the cases were less than 20 years of age and orbit (66.7%) was the commonest site of presentation in this series. Aberrant CD 19 expression on immunophenotyping was a common associate (66.9%) and t(8;21) was the commonest cytogenetic abnormality reported in our case series. Despite of high dose intensive therapy with daunorubicin and cytarabine followed by high-dose cytarabine (HiDAC) consolidation, patients had a median relapse-free survival and median overall survival of 160 days and 299.5 days respectively. Local radiotherapy for consolidation in two of our patients had no additional benefit. Conclusion: Myeloid sarcoma is extramedullary collection of myeloid blasts with or without bone marrow involvement. They were commonly seen in young patients and t(8;21) being a common cytogenetic abnormality associated with it. The treatment outcome of patients with myeloid sarcoma seems dismal and systemic therapy remains the modality of choice.

Management of autoimmune haemolytic anaemia in low-to-middle income countries: current challenges and the way forward

“…Although corticosteroids are recommended as a first line therapy mainly for wAIHA, in LMIC they are being used in all types of AIHA, partly due to the unavailability of the diagnostic facility for sub-typing. 1 , 8 , 60 Even in a retrospective study in which appropriate subtyping was performed, corticosteroids were the preferred therapeutic agents in CAD, resulting in only 14% response rate at 3 months of treatment and a “drug dependency” rate of 71% at 1 year, 61 probably explained by patients being maintained at high doses because of no real effect. 1 , 10 Similarly, current guidelines recommend rapid tapering and discontinuation of steroids from 3 weeks in non-responding primary wAIHA patients since continued treatment results in greater cumulative steroid toxicity while the probability of a late response is low.…”

“… 8 , 61 In clinical practice, therefore, AIHA patients face a high risk of being maintained on inappropriately high doses of corticosteroids, with an unnecessary risk of skeletal events, diabetes, and infection. 60 , 62 , 63 …”

“…To mitigate this unmet need to some extent, one might consider moving splenectomy upwards in the therapeutic algorithm for wAIHA as it is a cheap and efficacious treatment. 60 However, the disadvantages and precautions should still be observed. 1 , 4 …”