Successful treatment of histiocytic sarcoma with induction chemotherapy consisting of dose-escalated CHOP plus etoposide and upfront consolidation auto-transplantation

Abstract

Histiocytic sarcoma (HS) is an extremely rare malignant neoplasm that often exhibits an aggressive clinical presentation. In this report, we describe the case of a 38-year-old female with advanced-stage HS who was found to have a subcutaneous tumor in the left calf and enlarged lymph nodes in the left inguinal and internal iliac regions. The subcutaneous tumor and inguinal nodes were resected operatively. Immunohistochemistry of the surgical specimens showed that the malignant cells stained positive for CD163, CD68, and related markers; a diagnosis of HS was established. Following the administration of induction chemotherapy consisting of dose-escalated CHOP plus etoposide, the remaining internal iliac tumors disappeared. At that point, high-dose chemotherapy with autologous stem cell transplantation was performed as consolidation treatment. The patient remains alive with no evidence of disease for 30 months post-treatment. This report provides valuable insight into the treatment of advanced HS.

Histiocytic Sarcoma Associated with Coombs Negative Acute Hemolytic Anemia: A Rare Presentation

“…Importantly, the hemolytic anemia and thrombocytopenia resolved rapidly and completely after splenectomy. We then elected to treat our patient with adjuvant CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and oral prednisone) [ 9 , 10 ]. The PET-CT scans after 3 cycles of CHOP and at the end of therapy ( Figure 1(b) ) demonstrated no residual or recurrent FDG avid lesions.…”

Response to MEK inhibition with trametinib and tyrosine kinase inhibition with imatinib in multifocal histiocytic sarcoma

“…4 Few data exist for autologous and even less for allogeneic stem cell transplantation in the adult population, but some patients have shown favorable outcomes. 2,5,6 Thalidomide and alemtuzumab have been reported as potential therapies in single case reports, both in the pediatric or transplant setting.…”

Multiple masses on the face of a 58‐year‐old woman

“…Owing to its rarity, standard treatment strategies and prognostic factors are unavailable. Although localized cutaneous HS may show favorable prognosis, HS often follows an aggressive course with limited chemotherapeutic response . Surgical excision with or without adjuvant radiotherapy should be considered for resectable HS.…”

“…Surgical excision with or without adjuvant radiotherapy should be considered for resectable HS. For advanced or extracutaneous HS, standard CHOP therapy (cyclophosphamide, doxorubicin, vincristine, prednisone) and modified regimens, including addition of etoposide or BEAM regimens (carmustine, etoposide, cytarabine, and melphalan), can be considered . Detection of BRAF mutation or immune checkpoint pathways, including programmed death 1 and programmed death ligand 1, for immunotherapy has been reported …”