Abstract
Myeloid sarcoma (MS) as a solid extra-medullary (EM) manifestation of acute myeloid leukemia (AML), myeloproliferative or myelodysplastic syndromes is a rare presentation of relapse after allogeneic hematopoietic stem cell transplantation (HSCT). The databases of the Departments of Hematology and Oncology of the University Hospitals of Jena and Rostock were screened for patients aged 18 years or older for onset of MS after HSCT for myeloid malignancies between 2002 and 2019. Nineteen patients with MS were identified, the majority of whom had received reduced-intensity conditioning (RIC). The median onset of MS was 425 days after HSCT and the median overall survival since MS was 234 days. Although MS is associated with a poor prognosis, three patients survived more than two years and one more than 11 years after MS onset. These results indicate that RIC protocols may be associated with a higher risk of EM relapse. Since EM relapse occurred in the presence of Graft-versus-host-disease, these observations also demonstrate the limitations of graft-versus-tumor effects after HSCT. In conclusion, occurrence of MS after HSCT is associated with a poor prognosis, as multimodal curative concepts including intensive chemotherapy and another HSCT are often not viable.
Highlights
Myeloid sarcoma (MS), known as granulocytic sarcoma or chloroma, is defined as an extra-medullary (EM) and infiltrating tumor mass formation of blasts of one or more myeloid linages and maturating cells
The total number of patients receiving hematopoietic stem cell transplantation (HSCT) was not assessed for the whole time period at the University Hospital of Rostock
At the time of HSCT, 14 patients were in first complete remission (CR), 4 in second CR, and 1 had histologically confirmed partial response
Summary
Myeloid sarcoma (MS), known as granulocytic sarcoma or chloroma, is defined as an extra-medullary (EM) and infiltrating tumor mass formation of blasts of one or more myeloid linages and maturating cells. Manifestation of MS is a rare event [13], 19 patients presenting with MS as a sign of relapse of primary disease after allogeneic HSCT were identified at the University Hospitals Jena and Rostock (Germany) between January 2002 and December 2019. A systematic review of the literature on EM relapse after HSCT and treatment available on PubMed is provided
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