Abstract
BackgroundTo evaluate clinicopathological features, radiotherapeutic parameters, and their associations with responses to radiotherapy (RT) in patients with myeloid sarcoma (MS).MethodsWe reviewed 20 patients receiving RT for MS lesions (in 43 RT courses) and analyzed the patients’ clinicopathologic features and radiotherapeutic parameters, and their associations with complete responses (CR) to RT using Fisher’s exact test and univariate logistic regression analysis. Generalized Estimating Equation was used to analyze all 43 irradiated lesions and account for the correlations in RT responses among lesions from the same patient.ResultsWe found that the underlying hematological diseases of the evaluated patients were acute myeloid leukemia (AML) in 14 patients (70%), chronic myeloid leukemia in 4 patients (20%), myelodysplastic syndrome with AML transformation in one patient (5%), and de novo MS in one patient (5%). Most patients (55%) received RT for MS at the time of relapse following bone marrow transplantation (BMT). The most common cytogenetic abnormality was t(8;21)(q22;q22). The median RT dose of 20 Gy (range 6–35 Gy), administered in 1.5-3.5 Gy fractions, provided a 63% CR rate. RT dose, sex, cytogenetics, and bone marrow status at the time of RT had no significant effect on CR. Younger age (<50 y, P = 0.06), BMT prior to RT (P = 0.05), and underlying AML (P = 0.05) were marginally associated with higher CR to RT.ConclusionsOur results indicate that a modest RT dose (20-30 Gy) achieves good local control of MS. Age, previous BMT, and underlying hematologic disease can affect RT response.
Highlights
Myeloid sarcoma (MS), known as granulocytic sarcoma or chloroma, is a rare clinical condition characterized by aggregation of immature myeloid cells presenting as an extramedullary mass [1]
We investigated the possible underlying predictive factors, including clinicopathologic features and radiotherapeutic parameters, for response to RT in myeloid sarcoma (MS) patients who received frontline or palliative RT
We evaluated 20 patients and their irradiated lesions, and reviewed responses to RT and RT doses reported in previous studies on MS patients who received frontline or palliative RT
Summary
Myeloid sarcoma (MS), known as granulocytic sarcoma or chloroma, is a rare clinical condition characterized by aggregation of immature myeloid cells presenting as an extramedullary mass [1]. Chemotherapy or hematopoietic cell transplantation is often considered the frontline treatment for MS. Radiotherapy (RT) could be reserved for palliation of symptomatic or rapidly progressive lesions [5,6] or as part of a combined modality treatment in conjunction with chemotherapy or hematopoietic cell transplantation. RT is considered a consolidative treatment for isolated MS without BM involvement, or during BM remission after systemic therapy [7]. Radiotherapeutic parameters, and their associations with responses to radiotherapy (RT) in patients with myeloid sarcoma (MS)
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