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Yang J, Zhu X, Zhang H, Fu Y, Li Z, Xing Z, Yu Y, Cao P, Le J, Jiang J, Li J, Wang H, Zhai X. Prognostic Factors of Pediatric Acute Myeloid Leukemia Patients with t(8;21) (q22;q22): A Single-Center Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:605. [PMID: 38790600 PMCID: PMC11120327 DOI: 10.3390/children11050605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
This retrospective study aimed to analyze the treatment effect and prognostic factors of pediatric acute myeloid leukemia (AML) patients with t(8;21). A total of 268 newly diagnosed pediatric AML (pAML) enrolled from 1 January 2005 to 31 December 2022 were retrospectively reviewed, and 50 (18.7%) patients harbored t(8;21) translocation. CR rate, OS, EFS, and RFS were assessed by multivariate Logistic and Cox regression models in these patients. Of the 50 patients, 2 patients abandoned treatment during the first induction course. Of the remaining 48 patients who received double-induction therapy and were included in the final analyses, CR1 and CR2 were 75.0% (36/48) and 95.8% (46/48), respectively. The overall three-year OS, EFS, and RFS were 68.4% (95% CI, 55.0-85.1), 64.2% (95% CI, 50.7-81.4), and 65.5% (95% CI, 51.9-82.8), respectively. The presence of loss of sex chromosome (LOS) at diagnosis (n = 21) was associated with a better 3-year OS [87.5% (95% CI, 72.7-100) vs. 52.7% (95% CI, 35.1-79.3), p = 0.0089], 3-year EFS [81.6% (95% CI, 64.7-100) vs. 49.7% (95% CI, 32.4-76.4), p = 0.023], and 3-year RFS [81.6% (95% CI, 64.7-100) vs. 51.7% (95% CI, 33.9-78.9), p = 0.036] than those without LOS (n = 27), and it was also an independent good prognostic factor of OS (HR, 0.08 [95% CI, 0.01-0.48], p = 0.005), EFS (HR, 0.22 [95% CI, 0.05-0.85], p = 0.029), and RFS (HR, 0.21 [95% CI, 0.05-0.90], p = 0.035). However, extramedullary leukemia (EML) featured the independent risk factors of inferior OS (HR, 10.99 [95% CI, 2.08-58.12], p = 0.005), EFS (HR, 4.75 [95% CI, 1.10-20.61], p = 0.037), and RFS (HR, 6.55 [95% CI, 1.40-30.63], p = 0.017) in pediatric individuals with t(8;21) AML. Further analysis of combining LOS with EML indicated that the EML+LOS- subgroup had significantly inferior OS (92.9%, [95% CI, 80.3-100]), EFS (86.2%, [95% CI, 70.0-100]), and RFS (86.2%, [95% CI, 80.3-100]) compared to the other three subgroups (all p < 0.001). LOS and EML are independent prognostic factors of OS, EFS, and RFS with t(8;21) pAML patients. LOS combined with EML may help improve risk stratification.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Xiaowen Zhai
- Department of Hematology and Oncology, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai 201102, China
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Kanitthamniyom C, Wannaphut C, Pattanaprichakul P, Kungwankiattichi S, Owattanapanich W. Organomegalies as a predictive indicator of leukemia cutis in patients with acute myeloid leukemia. PLoS One 2024; 19:e0297805. [PMID: 38363781 PMCID: PMC10871476 DOI: 10.1371/journal.pone.0297805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Leukemia cutis (LC) is an extramedullary acute myeloid leukemia (AML) infiltrate. No previous study has described the clinical characteristics and outcomes of Thai patients diagnosed with AML with LC. MATERIALS AND METHODS We conducted a 7-year retrospective case-control study on Thai AML patients at Siriraj Hospital from November 2013 to July 2020. Patients were divided into LC and non-LC groups. Initial clinical presentations and laboratory findings were examined to identify LC-associated factors. Overall survival (OS) and relapse-free survival (RFS) were assessed. Pathological tissues underwent re-evaluation to validate the LC diagnoses. RESULTS The study included 159 patients in a 2:1 ratio (106 non-LC and 53 LC). The LC group had a mean ± SD age of 54.3 ± 15.5 years; females were predominant. Three-fifths of the LC patients had intermediate-risk cytogenetics; 20.4% had an adverse risk, and 10.2% had a favorable risk. Most were classified as AML-M4 and AML-M5. Leukemic nodules were the primary finding in 58.5% of the cases, mainly on the legs. In the multivariate analysis of predictive factors associated with LC, organomegalies, specifically hepatomegaly, and lymphadenopathy, remained significant factors associated with LC [OR 4.45 (95%CI 1.20, 16.50); p = 0.026 and OR 5.48 (95%CI 1.65, 18.20); p = 0.005], respectively. The LC group demonstrated a significantly reduced OS (log-rank test p = 0.002) (median OS of 8.6 months vs. 32.4 months). RFS was considerably lower in the LC group (log-rank test p = 0.001) (median duration of 10.3 months vs. 24.4 months in the non-LC). CONCLUSIONS AML patients who developed LC tended to experience notably poorer prognoses. Therefore, it is imperative to consider aggressive treatment options for such individuals. The presence of organomegalies in AML patients serves as a strong predictor of the possible occurrence of LC when accompanied by skin lesions.
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Affiliation(s)
- Chanakarn Kanitthamniyom
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalothorn Wannaphut
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Penvadee Pattanaprichakul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Smith Kungwankiattichi
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Center of Excellence of Siriraj Adult Acute Myeloid/Lymphoblastic Leukemia (SiAML), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerapat Owattanapanich
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Center of Excellence of Siriraj Adult Acute Myeloid/Lymphoblastic Leukemia (SiAML), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Bae S, Sa S, Park S, Cho BS, Kim HJ. Limited Efficacy of Venetoclax Combination Regimens in Acute Myeloid Leukemia with Extramedullary Relapse. Acta Haematol 2023; 147:352-359. [PMID: 37751714 DOI: 10.1159/000534026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
The recently approved BCL2 inhibitor venetoclax (VEN) has achieved promising outcomes in new and relapsed/refractory (R/R) acute myeloid leukemia (AML). Although its use is not well established in R/R AML with extramedullary disease (EMD), some reports have shown promising outcomes. We retrospectively analyzed 11 patients of R/R AML with EMD (with (n = 4) or without (n = 7) concurrent marrow involvement), who were treated with VEN plus decitabine (n = 9) or low-dose cytarabine (n = 2) between May 2020 and October 2020 in Seoul St. Mary's Hospital. The median number of prior treatment lines was 3 (1-6), and most (n = 9, 81.8%) had multiple sites of EMD. Nine patients (81.8%) received concurrent therapy for extramedullary (EM) involvement sites with radiotherapy (RT) (n = 4), surgery (n = 1), and both of them (n = 4). Among 11 patients, 4 patients (36.4%) had either marrow or EM responses to VEN combination; EM response was seen in 1 patient (9.1%, partial response) who had received concurrent RT (25 Gy, 10 fx) during the 1st cycle of VEN combination, and other 3 patients showed marrow response without EM response. After median follow-up of 27.0 months, the median overall survival was estimated to be 5.4 months. To conclude, VEN combination regimens have shown only modest efficacy in EM recurrence of AML with little impact on eliciting EM response.
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Affiliation(s)
- Soyoung Bae
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungwon Sa
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Silvia Park
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Sik Cho
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Farge T, Nakhle J, Lagarde D, Cognet G, Polley N, Castellano R, Nicolau ML, Bosc C, Sabatier M, Sahal A, Saland E, Jeanson Y, Guiraud N, Boet E, Bergoglio C, Gotanègre M, Mouchel PL, Stuani L, Larrue C, Sallese M, De Mas V, Moro C, Dray C, Collette Y, Raymond-Letron I, Ader I, Récher C, Sarry JE, Cabon F, Vergez F, Carrière A. CD36 Drives Metastasis and Relapse in Acute Myeloid Leukemia. Cancer Res 2023; 83:2824-2838. [PMID: 37327406 PMCID: PMC10472106 DOI: 10.1158/0008-5472.can-22-3682] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/31/2023] [Accepted: 06/12/2023] [Indexed: 06/18/2023]
Abstract
Identifying mechanisms underlying relapse is a major clinical issue for effective cancer treatment. The emerging understanding of the importance of metastasis in hematologic malignancies suggests that it could also play a role in drug resistance and relapse in acute myeloid leukemia (AML). In a cohort of 1,273 AML patients, we uncovered that the multifunctional scavenger receptor CD36 was positively associated with extramedullary dissemination of leukemic blasts, increased risk of relapse after intensive chemotherapy, and reduced event-free and overall survival. CD36 was dispensable for lipid uptake but fostered blast migration through its binding with thrombospondin-1. CD36-expressing blasts, which were largely enriched after chemotherapy, exhibited a senescent-like phenotype while maintaining their migratory ability. In xenograft mouse models, CD36 inhibition reduced metastasis of blasts and prolonged survival of chemotherapy-treated mice. These results pave the way for the development of CD36 as an independent marker of poor prognosis in AML patients and a promising actionable target to improve the outcome of patients. SIGNIFICANCE CD36 promotes blast migration and extramedullary disease in acute myeloid leukemia and represents a critical target that can be exploited for clinical prognosis and patient treatment.
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Affiliation(s)
- Thomas Farge
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases, Team CERAMIC, INSERM, Paul Sabatier University, UMR1297, Toulouse, France
- Institut Fédératif de Biologie (IFB), CHU Toulouse, Toulouse, France
- RESTORE Research Center, Université Toulouse Paul Sabatier, INSERM 1301, CNRS 5070, EFS, ENVT, Toulouse, France
| | - Jean Nakhle
- RESTORE Research Center, Université Toulouse Paul Sabatier, INSERM 1301, CNRS 5070, EFS, ENVT, Toulouse, France
| | - Damien Lagarde
- RESTORE Research Center, Université Toulouse Paul Sabatier, INSERM 1301, CNRS 5070, EFS, ENVT, Toulouse, France
- McGill University, Rosalind and Morris Goodman Cancer Institute, Montréal, Québec, Canada
- McGill University, Department of Biochemistry, Montréal, Québec, Canada
| | - Guillaume Cognet
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Nathaniel Polley
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Rémy Castellano
- Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Marie-Laure Nicolau
- University of Toulouse, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Service d'Hématologie, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Claudie Bosc
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Marie Sabatier
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Ambrine Sahal
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Estelle Saland
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Yannick Jeanson
- RESTORE Research Center, Université Toulouse Paul Sabatier, INSERM 1301, CNRS 5070, EFS, ENVT, Toulouse, France
| | - Nathan Guiraud
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Emeline Boet
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Camille Bergoglio
- Institute of Metabolic and Cardiovascular Diseases, Team MetaDiab, INSERM, Paul Sabatier University, UMR1297, Toulouse, France
| | - Mathilde Gotanègre
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Pierre-Luc Mouchel
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
- University of Toulouse, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Service d'Hématologie, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Lucille Stuani
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Clément Larrue
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Marie Sallese
- RESTORE Research Center, Université Toulouse Paul Sabatier, INSERM 1301, CNRS 5070, EFS, ENVT, Toulouse, France
| | - Véronique De Mas
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
- University of Toulouse, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Service d'Hématologie, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Cedric Moro
- Institute of Metabolic and Cardiovascular Diseases, Team MetaDiab, INSERM, Paul Sabatier University, UMR1297, Toulouse, France
| | - Cédric Dray
- RESTORE Research Center, Université Toulouse Paul Sabatier, INSERM 1301, CNRS 5070, EFS, ENVT, Toulouse, France
| | - Yves Collette
- Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Isabelle Raymond-Letron
- RESTORE Research Center, Université Toulouse Paul Sabatier, INSERM 1301, CNRS 5070, EFS, ENVT, Toulouse, France
- LabHPEC, Université de Toulouse, ENVT, Toulouse, France
| | - Isabelle Ader
- RESTORE Research Center, Université Toulouse Paul Sabatier, INSERM 1301, CNRS 5070, EFS, ENVT, Toulouse, France
| | - Christian Récher
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
- University of Toulouse, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Service d'Hématologie, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Jean-Emmanuel Sarry
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - Florence Cabon
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
| | - François Vergez
- Centre de Recherches en Cancérologie de Toulouse, Université de Toulouse, Inserm, CNRS, Toulouse, France
- LabEx Toucan, Toulouse, France
- Equipe Labellisée Ligue Nationale Contre le Cancer 2023, Toulouse, France
- University of Toulouse, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Service d'Hématologie, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Audrey Carrière
- RESTORE Research Center, Université Toulouse Paul Sabatier, INSERM 1301, CNRS 5070, EFS, ENVT, Toulouse, France
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Loscocco GG, Vannucchi AM. Myeloid sarcoma: more and less than a distinct entity. Ann Hematol 2023:10.1007/s00277-023-05288-1. [PMID: 37286874 DOI: 10.1007/s00277-023-05288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023]
Abstract
Myeloid sarcoma (MS) is a distinct entity among myeloid neoplasms defined as a tumour mass of myeloid blasts occurring at an anatomical site other than the bone marrow, in most cases concomitant with acute myeloid leukaemia (AML), rarely without bone marrow involvement. MS may also represent the blast phase of chronic myeloproliferative neoplasms (MPN) and myelodysplastic syndromes (MDS). However, the clinical and molecular heterogeneity of AML, as highlighted by the 2022 World Health Organization (WHO) and International Consensus (ICC) classifications, indirectly define MS more as a set of heterogeneous and proteiform diseases, rather than a homogeneous single entity. Diagnosis is challenging and relies mainly on histopathology, immunohistochemistry, and imaging. Molecular and cytogenetic analysis of MS tissue, particularly in isolated cases, should be performed to refine the diagnosis, and thus assign prognosis guiding treatment decisions. If feasible, systemic therapies used in AML remission induction should be employed, even in isolated MS. Role and type of consolidation therapy are not univocally acknowledged, and systemic therapies, radiotherapy, or allogeneic hematopoietic stem cell transplantation (allo-HSCT) should be considered. In the present review, we discuss recent information on MS, focusing on diagnosis, molecular findings, and treatments also considering targetable mutations by recently approved AML drugs.
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Affiliation(s)
- Giuseppe G Loscocco
- Department of Experimental and Clinical Medicine, CRIMM, Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
- Doctorate School GenOMec, University of Siena, Siena, Italy
| | - Alessandro M Vannucchi
- Department of Experimental and Clinical Medicine, CRIMM, Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.
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Ball S, Knepper TC, Deutsch YE, Samra W, Watts JM, Bradley TJ, Chan O, Hussaini MO, Zhang L, Sweet KL, Kuykendall AT, Talati C, Padron E, Komrokji RS, Lancet JE, Sallman DA. Molecular annotation of extramedullary acute myeloid leukemia identifies high prevalence of targetable mutations. Cancer 2022; 128:3880-3887. [DOI: 10.1002/cncr.34459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/05/2022] [Accepted: 07/20/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Somedeb Ball
- Division of Hematology and Medical Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Todd C. Knepper
- Department of Individualized Cancer Management H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Yehuda E. Deutsch
- Department of Malignant Hematology and Cellular Therapy at Memorial Healthcare System Moffitt Cancer Center Pembroke Pines Florida USA
| | - Wassim Samra
- Sylvester Comprehensive Cancer Center University of Miami Miami Florida USA
| | - Justin M. Watts
- Sylvester Comprehensive Cancer Center University of Miami Miami Florida USA
| | | | - Onyee Chan
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Mohammad Omar Hussaini
- Department of Hematopathology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Ling Zhang
- Department of Hematopathology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Kendra L. Sweet
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Andrew T. Kuykendall
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Chetasi Talati
- Abbvie Inc. (formerly affiliated to Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA) North Chicago Illinois USA
| | - Eric Padron
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Rami S. Komrokji
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Jeffrey E. Lancet
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - David A. Sallman
- Department of Malignant Hematology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
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Samborska M, Barańska M, Wachowiak J, Skalska-Sadowska J, Thambyrajah S, Czogała M, Balwierz W, Kołtan S, Peszyńska-Żelazny K, Wysocki M, Ociepa T, Urasiński T, Wróbel G, Węcławek-Tompol J, Ukielska B, Chybicka A, Kitszel A, Krawczuk-Rybak M, Szmydki-Baran A, Malinowska I, Matysiak M, Mizia-Malarz A, Tomaszewska R, Szczepański T, Chodała-Grzywacz A, Karolczyk G, Maciejka-Kembłowska L, Irga-Jaworska N, Badowska W, Dopierała M, Kurzawa P, Derwich K. Clinical Characteristics and Treatment Outcomes of Myeloid Sarcoma in Children: The Experience of the Polish Pediatric Leukemia and Lymphoma Study Group. Front Oncol 2022; 12:935373. [PMID: 35875115 PMCID: PMC9300998 DOI: 10.3389/fonc.2022.935373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022] Open
Abstract
IntroductionMyeloid sarcoma (MS) is an extramedullary malignant tumor composed of immature myeloid cells. It occurs in patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or chronic myeloid leukemia (CML). MS may coincide with disease diagnosis or precede bone marrow involvement by months or even years; it can also represent the extramedullary manifestation of a relapse (1, 2).AimThe aim of this study is to describe clinical characteristics of children diagnosed with MS in Poland as well as to analyze diagnostic methods, treatment, and outcomes including overall survival (OS), relapse-free survival (RFS), and event-free survival (EFS). The study also attempted to identify factors determining treatment outcomes.PatientsThe study group comprised 43 patients (F=18, M=25) aged 0-18 years (median age, 10.0 years; mean age, 8.8 years) diagnosed with MS based on tumor biopsy and immunohistochemistry or identification of underlying bone marrow disease and extramedullary tumor according to imaging findings.MethodsThe clinical data and diagnostic and therapeutic methods used in the study group were analyzed. A statistical analysis of the treatment outcomes was conducted with STATISTICA v. 13 (StatSoft, Inc., Tulsa, OK, USA) and analysis of survival curves was conducted with MedCalc 11.5.1 (MedCalc Software, Ostend, Belgium). Statistical significance was considered at p<0.05.ResultsIn the study group, MS was most frequently accompanied by AML. The most common site of involvement was skin, followed by orbital region. Skin manifestation of MS was more common in the age group <10 years. The most frequent genetic abnormality was the t(8;21)(q22;q22) translocation. The 5-year OS probability (pOS), 5-year RFS probability (pRFS), and 5-year EFS probability (pEFS) were 0.67 ± 0.08, 0.79 ± 0.07, and 0.65 ± 0.08, respectively. In patients with isolated MS and those with concurrent bone marrow involvement by AML/MDS, pOS values were 0.56 ± 0.12 and 0.84 ± 0.09 (p=0.0251), respectively, and pEFS values were 0.56 ± 0.12 and 0.82 ± 0.08 (p=0.0247), respectively. In patients with and without the t(8;21)(q22;q22) translocation, pEFS values were 0.90 ± 0.09 and 0.51 ± 0.14 (p=0.0490), respectively.ConclusionsMS is a disease with a highly variable clinical course. Worse treatment outcomes were observed in patients with isolated MS compared to those with concurrent bone marrow involvement by AML/MDS. Patients with the t(8;21)(q22;q22) translocation were found to have significantly higher pEFS. MS location, age group, chemotherapy regimen, surgery, and/or radiotherapy did not have a significant influence on treatment outcomes. Further exploration of prognostic factors in children with MS is indicated.
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Affiliation(s)
- Magdalena Samborska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
- *Correspondence: Magdalena Samborska,
| | - Małgorzata Barańska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
| | - Jolanta Skalska-Sadowska
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
| | - Sheanda Thambyrajah
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
| | - Małgorzata Czogała
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Kraków, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, University Children’s Hospital, Kraków, Poland
| | - Sylwia Kołtan
- Department of Paediatrics, Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Katarzyna Peszyńska-Żelazny
- Department of Paediatrics, Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Mariusz Wysocki
- Department of Paediatrics, Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-oncology and Pediatric Gastroenterology, Independent Public Clinical Hospital No. 1, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-oncology and Pediatric Gastroenterology, Independent Public Clinical Hospital No. 1, Pomeranian Medical University, Szczecin, Poland
| | - Grażyna Wróbel
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Supraregional Center of Pediatric Oncology “Cape of Hope”, Wrocław, Poland
| | - Jadwiga Węcławek-Tompol
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Supraregional Center of Pediatric Oncology “Cape of Hope”, Wrocław, Poland
| | - Bogna Ukielska
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Supraregional Center of Pediatric Oncology “Cape of Hope”, Wrocław, Poland
| | - Alicja Chybicka
- Department of Bone Marrow Transplantation, Pediatric Oncology and Hematology, Supraregional Center of Pediatric Oncology “Cape of Hope”, Wrocław, Poland
| | - Anna Kitszel
- Department of Pediatrics, Oncology and Hematology, L. Children’s Clinical Hospital, Białystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatrics, Oncology and Hematology, L. Children’s Clinical Hospital, Białystok, Poland
| | - Anna Szmydki-Baran
- Department of Pediatric Oncology and Hematology, Independent Public Children’s Teaching Hospital, Warsaw, Poland
| | - Iwona Malinowska
- Department of Pediatric Oncology and Hematology, Independent Public Children’s Teaching Hospital, Warsaw, Poland
| | - Michał Matysiak
- Department of Pediatric Oncology and Hematology, Independent Public Children’s Teaching Hospital, Warsaw, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Renata Tomaszewska
- Department of Pediatrics, Pediatric Hematology and Oncology in Zabrze, Stanisław Szyszko Independent Public University Hospital No. 1, Medical University of Silesia, Katowice, Poland
| | - Tomasz Szczepański
- Department of Pediatrics, Pediatric Hematology and Oncology in Zabrze, Stanisław Szyszko Independent Public University Hospital No. 1, Medical University of Silesia, Katowice, Poland
| | | | - Grażyna Karolczyk
- Department of Pediatric Oncology and Hematology, Provincial Integrated Hospital, Kielce, Poland
| | | | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, University Clinical Centre, Gdańsk, Poland
| | - Wanda Badowska
- Department of Pediatric Oncology and Hematology, Provincial Specialist Children’s Hospital, Olsztyn, Poland
| | - Michał Dopierała
- Department of Clinical Pathology, Poznań University of Medical Sciences, Poznań, Poland
| | - Paweł Kurzawa
- Department of Clinical Pathology, Poznań University of Medical Sciences, Poznań, Poland
| | - Katarzyna Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznań University of Medical Sciences, Poznań, Poland
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Hoxa11-mediated reduction of cell migration contributes to myeloid sarcoma formation induced by cooperation of MLL/AF10 with activating KRAS mutation in a mouse transplantation model. Neoplasia 2022; 29:100802. [PMID: 35500545 PMCID: PMC9065885 DOI: 10.1016/j.neo.2022.100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/18/2022] [Indexed: 12/02/2022]
Abstract
Acute myeloid leukemia (AML) patients with MLL translocations (MLL-t) are frequently found to harbor N-/K-RAS activating mutations. Mouse models revealed that cooperating mutations accelerated leukemia development and myeloid sarcoma formation. The molecular mechanism of accelerated leukemia development and myeloid sarcoma formation is not clear. In this study, we demonstrate Hoxa10 accelerated leukemia development and are the first to show that Hoxa11 controls migration and retention of leukemia cell at extramedullary sites and is a key player in myeloid sarcoma formation.
The molecular mechanism of myeloid sarcoma (MS) formation remains nuclear. Our clinical and mouse model findings from a previous study revealed that cooperation of KMT2A (MLL) translocation (MLL-t) with activating N-/K-RAS mutations promoted MS formation in a shorter latency. To improve the understanding of MS formation, in this study, we performed imaging cell trafficking analysis and demonstrated that cells harboring cooperating mutations migrated more slowly to omental adipose tissues and more cells were retained in adipose tissues in vivo. Comparison of transcriptome profiling among three pairs of mouse MLL/AF10(OM-LZ) leukemia cell lines harboring activating and wild-type KRAS identified 77 differentially expressed genes (DEGs) with >1.5-fold change. Functional annotation of these 77 DEGs using Gene Ontology (GO) enrichment analysis followed by cluster analysis revealed that GO terms related to development/differentiation have the highest enrichment score. The roles of Hoxa10 and Hoxa11, two genes which mapped to this cluster, were further characterized. Silencing Hoxa10 and Hoxa11 in cells harboring cooperating mutations prolonged the survival and reduced MS formation, respectively, in the recipient mice. Data of imaging cell trafficking as well as competitive engraftment and clonal expansion analyses indicated that silencing or overexpressing Hoxa11 in mouse leukemia cells affected cell migration and retention in omental adipose tissue. Although silencing Hoxa11 in leukemia cells did not affect Cxcr4 expression, it resulted in increased transwell migration, motility in confined spaces 3 μm in size, and cell protrusion. Our results revealed that Hoxa10 plays an important role in survival and Hoxa11 contributes to MS formation in MLL-t acute myeloid leukemia with activating KRAS mutation.
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Kolonen A, Sinisalo M, Huhtala H, Rimpiläinen J, Rintala H, Sankelo M, Koivunen E, Silvennoinen R, Räty R, Ruutu T, Volin L, Porkka K, Jantunen E, Nousiainen T, Kuittinen T, Penttilä K, Pyörälä M, Säily M, Koistinen P, Kauppila M, Itälä-Remes M, Ollikainen H, Rauhala A, Kairisto V, Pelliniemi TT, Elonen E. Efficacy of conventional-dose cytarabine, idarubicin and thioguanine versus intermediate-dose cytarabine and idarubicin in the induction treatment of acute myeloid leukemia: Long-term results of the prospective randomized nationwide AML-2003 study by the Finnish Leukemia Group. Eur J Haematol Suppl 2022; 109:257-270. [PMID: 35634931 DOI: 10.1111/ejh.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES AML-2003 study sought to compare the long-term efficacy and safety of IAT and IdAraC-Ida in induction chemotherapy of acute myeloid leukemia (AML) and introduce the results of an integrated genetic and clinical risk classification guided treatment strategy. METHODS Patients were randomized to receive either IAT or IdAraC-Ida as the first induction treatment. Intensified postremission strategies were employed based on measurable residual disease (MRD) and risk classification. Structured questionnaire forms were used to gather data prospectively. RESULTS A total of 356 AML patients with a median age of 53 years participated in the study. Long-term overall survival (OS) and relapse-free survival (RFS) were both 49% at 10 years. The median follow-up was 114 months. No significant difference in remission rate, OS or RFS was observed between the two induction treatments. Risk classification according to the protocol, MRD after the first and the last consolidation treatment affected the OS and RFS significantly (p < .001). CONCLUSIONS Intensified cytarabine dose in the first induction treatment was not better than IAT in patients with AML. Intensification of postremission treatment in patients with clinical risk factors or MRD seems reasonable, but randomized controlled studies are warranted in the future.
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Affiliation(s)
- Aarne Kolonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Johanna Rimpiläinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Hannele Rintala
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Marja Sankelo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Elli Koivunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Raija Silvennoinen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Riikka Räty
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
| | - Tapani Ruutu
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
| | - Liisa Volin
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
| | - Kimmo Porkka
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
| | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tapio Nousiainen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Taru Kuittinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Karri Penttilä
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Marja Pyörälä
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Marjaana Säily
- Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Pirjo Koistinen
- Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Marjut Kauppila
- Stem Cell Transplantation Unit, Turku University Hospital, Turku, Finland
| | - Maija Itälä-Remes
- Stem Cell Transplantation Unit, Turku University Hospital, Turku, Finland
| | - Hanna Ollikainen
- Department of Medicine, Satakunta Central Hospital, Pori, Finland
| | - Auvo Rauhala
- The Faculty of Education and Welfare Studies, Department of Health Sciences, Åbo Akademi University, Vaasa, Finland.,Client and Patient Safety Center, Vaasa Central Hospital, Vaasa, Finland
| | - Veli Kairisto
- Laboratory of Molecular Haematology and Pathology, Turku University Central Hospital, Turku, Finland
| | - Tarja-Terttu Pelliniemi
- Department of Clinical Chemistry, University of Turku, Finland and Fimlab Laboratories Ltd, Tampere, Finland
| | - Erkki Elonen
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
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10
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Choi KH, Song JH, Kwak YK, Lee JH, Jang HS. Analysis of PET parameters predicting response to radiotherapy for myeloid sarcoma. PLoS One 2021; 16:e0261550. [PMID: 34929016 PMCID: PMC8687562 DOI: 10.1371/journal.pone.0261550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Positron-emission tomography (PET)-CT has recently been used for diagnostic imaging and radiotherapy for myeloid sarcoma, but there is little research on predicting the response of radiotherapy. The aim of this study was to analyze the association between PET-CT variables and the response to radiotherapy in patients with myeloid sarcoma. Materials and methods This study was conducted in myeloid sarcoma patients who received radiotherapy and PET-CT before and after radiotherapy. The response to radiotherapy was evaluated based on the European Organization for Research and Treatment of Cancer PET response criteria, and binary regression analysis was performed to assess the factors predicting reductions in the maximum standardized uptake value (SUVmax). Results Twenty-seven sites in 12 patients were included in the study. Complete metabolic responses were seen in 24 patients after radiotherapy, a partial metabolic response in one, and progressive metabolic disease in two patients. The prescribed dose of more than 3000 cGy10 was significantly greater in the treatment control group (P = 0.024). In binary logistic regression analysis predicting reductions in the SUVmax of more than 70% after radiotherapy, the pretreatment SUVmax (≥ 7.5) and further chemotherapy after radiotherapy showed significant differences in univariate and multivariate analyses. Conclusion Good metabolic responses (complete or partial) to radiotherapy were achieved in 92.6% of the myeloid sarcoma patients. Radiation doses < 3000 cGy10 and increased SUVmax were related to treatment failure and high SUVmax before radiotherapy was a factor influencing SUVmax reduction. Further large-scale studies are needed.
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Affiliation(s)
- Kyu Hye Choi
- Department of Radiation Oncology, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo-Kang Kwak
- Department of Radiation Oncology, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, Saint Vincent's Hospital, chlrb2 College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hong Seok Jang
- Department of Radiation Oncology, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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CNS involvement in AML at diagnosis is rare and does not affect response or survival: data from 11 ECOG-ACRIN trials. Blood Adv 2021; 5:4560-4568. [PMID: 34597373 PMCID: PMC8759130 DOI: 10.1182/bloodadvances.2021004999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/07/2021] [Indexed: 11/20/2022] Open
Abstract
There was no significant difference in CR rate and OS among patients with CNS involvement, other EMD, or no EMD. The incidence of CNS involvement of newly diagnosed AML is low, irrespective of whether an LP is mandatory or not.
Central nervous system (CNS) involvement in patients with newly diagnosed acute myeloid leukemia (AML) is rare, and systematic data regarding outcome are scarce. This retrospective study summarized data from 11 consecutive Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) clinical trials for patients with newly diagnosed AML. In all, 3240 patients with AML were analyzed, and 36 (1.11%) were found to have CNS involvement at diagnosis. The incidence of CNS disease among the 5 studies with per protocol mandatory lumbar puncture (LP) was similar to the incidence among studies in which LP was performed at the discretion of the investigator (0.86% vs 1.41%; P = .18). There was no significant difference in the rate of complete remission (CR) among patients with CNS involvement and those with other extramedullary disease (EMD) sites or those with no EMD (52.8% vs 59.3%-60%). The median overall survival (OS) for patients who were CNS positive, who had other EMD, or who had no EMD was 11.4, 11.3, and 12.7 months, respectively. There was no difference in OS among patients with CNS involvement, those with other EMD (hazard ratio [HR], 0.96; adjusted P = .84), and those with no EMD (HR, 1.19; adjusted P = .44). In conclusion, the reported incidence of CNS involvement in patients with newly diagnosed AML is low (1.1%), irrespective of whether an LP is mandatory or not. The presence of CNS disease at diagnosis in and of itself does not seem to portend a poor prognosis for achieving an initial CR or for OS.
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12
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Gastrointestinal Myeloid Sarcoma a Case Presentation and Review of the Literature. Mediterr J Hematol Infect Dis 2021; 13:e2021067. [PMID: 34804441 PMCID: PMC8577557 DOI: 10.4084/mjhid.2021.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022] Open
Abstract
Myeloid sarcomas can be detected in up to 30% of acute myeloid leukemia cases or occur de-novo without bone marrow involvement. The most frequent localization of myeloid sarcomas in the abdominal cavity is the small intestine, and gastric presentations are infrequent, frequently misdiagnosed, and a high level of suspicion should exist when the characteristic histomorphology features are present. The current review features a case report with gastric presentation of myeloid sarcoma in a patient with a diagnosis of acute myeloid leukemia with trisomy 8. In addition, a review of the literature of intestinal-type myeloid sarcomas shows that less than 15% of these cases have been reported in the stomach. The most common molecular aberrancy detected in intestinal myeloid sarcomas is the fusion protein CBFB-MYH11. A review of several large studies demonstrates that the presence of myeloid sarcoma does not constitute an independent prognostic factor. The therapeutic approach will be tailored to the specific genetic abnormalities present, and systemic chemotherapy with hematopoietic stem cell transplant is the most efficient strategy.
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13
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Pearson LK, Hamal R, Yu S, Miller KB, Mensah F. Chloroma of the Bladder: A Case Report of Leukemia Progression Presenting as Hematuria. Case Rep Oncol 2021; 14:1366-1372. [PMID: 34720943 PMCID: PMC8525298 DOI: 10.1159/000518529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022] Open
Abstract
Myeloid sarcoma (MS) is a rare extramedullary manifestation of acute myelogenous leukemia (AML). The mass is composed of primitive myeloid cells that can occur in a variety of organs, most commonly the skin, lymph nodes, GI tract, bone, breast, and CNS. Involvement of the genitourinary tract is rare. Consensus on treatment of MS has not been established, but management typically involves systemic therapy, such as chemotherapy or allogeneic hematopoietic stem cell transplant as well as palliative local therapies such as radiation or surgery. Outcomes of MS using novel AML therapies, such as BCL-2 inhibitors or IDH inhibitors, remain undescribed. We describe a rare case of a 70-year-old man presenting with MS of the urinary bladder complicating known secondary AML (RUNX1 and IDH2 mutated). Prior to development of bladder MS, the patient had received decitabine, enasidenib, and venetoclax. Following diagnosis, he was treated with cytarabine and venetoclax. To our knowledge, this is the first case of bladder MS treated with a BCL-2 inhibitor.
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Affiliation(s)
- Laurie K Pearson
- Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ruchi Hamal
- Department of Hematology and Oncology, Mt Auburn Hospital, Cambridge, Massachusetts, USA
| | - Sanhong Yu
- Department of Lab Medicine and Pathology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Kenneth B Miller
- Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Felix Mensah
- Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts, USA
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[Isolated myeloid sarcoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:878-880. [PMID: 34788931 PMCID: PMC8607019 DOI: 10.3760/cma.j.issn.0253-2727.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Prognostic value of measurable residual disease at allogeneic transplantation for adults with core binding factor acute myeloid leukemia in complete remission. Bone Marrow Transplant 2021; 56:2779-2787. [PMID: 34272486 DOI: 10.1038/s41409-021-01409-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/05/2021] [Indexed: 12/14/2022]
Abstract
Pretransplant measurable residual disease (MRD) has been shown to be associated with relapse incidence following allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML). However, it remains less clear whether pretransplant MRD status affects transplant outcomes in core binding factor AML (CBF-AML). We retrospectively evaluated the effect of pretransplant MRD, which was measured by a polymerase chain reaction of RUNX1-RUNX1T1 or CBFB-MYH11 fusion transcripts, on transplant outcomes for a cohort of 959 adult patients with t(8;21) or inv(16) AML treated by allogeneic HCT during complete remission (CR), between 2000 and 2018. Multivariate analysis showed the absence of pretransplant MRD was significantly associated with lower relapse (hazard ratio [HR], 0.46; P < 0.001), treatment failure (HR, 0.66; P = 0.004), and overall mortality (HR, 0.72; P = 0.037) among patients with t(8;21). However, pretransplant MRD negativity was not associated with relapse (HR, 0.73; P = 0.420), treatment failure (HR, 0.64; P = 0.063), or overall mortality (HR, 0.69; P = 0.149) among patients with inv(16). In subgroup analysis, pretransplant MRD status significantly affected relapse and LFS only in patients with t(8;21) undergoing allogeneic HCT during CR2. In conclusion, our data demonstrate the different prognostic values of pretransplant MRD for CBF-AML, highlighting the need to develop effective therapeutic strategies for such MRD-positive patients.
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Fianchi L, Quattrone M, Criscuolo M, Bellesi S, Dragonetti G, Maraglino AME, Bonanni M, Chiusolo P, Sica S, Pagano L. Extramedullary Involvement in Acute Myeloid Leukemia. A Single Center Ten Years' Experience. Mediterr J Hematol Infect Dis 2021; 13:e2021030. [PMID: 34007418 PMCID: PMC8114885 DOI: 10.4084/mjhid.2021.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/09/2021] [Indexed: 11/08/2022] Open
Abstract
The incidence, risk factors, and prognostic significance of extramedullary involvement (EMI) in adult patients with acute myeloid leukemia (AML) have not been established yet. This study analyzed clinical and biological characteristics, the impact on prognosis, and the cumulative incidence of EMI in a monocentric retrospective series. All adult patients diagnosed with AML observed in our institution between January 2010 and December 2017 were included in the analysis. Overall, 346 AMLs were analyzed. The incidence of EMI was 11% (38 patients). The involved sites were: skin (66%), central nervous system (CNS) (23%), pleura (7%), lymph nodes (5%), peritoneum (2%), spleen (2%), pancreas (2%), breasts (2%) and bones (2%). Most patients (91%) had only one EMI site, while 9% had multiple sites affected at the same time. Twenty-four (63%) patients showed signs of EMI at presentation, while extramedullary relapse occurred in 10 patients (26%); 4 patients had EMI both at presentation and relapse. EMI had a significantly higher frequency in patients with monocytic and myelo-monocytic leukemia subtypes (p<0,0001), CD117-negative (p=0,03) at flow cytometry analysis, MLL rearrangements (p=0.001), trisomy 8 (p=0,02). An analysis regarding treatment, overall survival (OS), and disease-free survival (DFS) was performed only on the 28 patients who experienced EMI at the onset of their disease; one EMI patient receiving best supportive care was excluded from OS analysis. The other 27 patients were treated with: conventional chemotherapy (21 patients), hypomethylating agents (5 patients), and low dose cytarabine (1 patient); 8 patients only (28.5%) received an allogeneic stem cell transplantation (allo-HSCT). After induction therapy, complete remission (CR) rate was 22%, with a median DFS of 7.4 months. The median OS of all 27 EMI patients was 11.6 months (range 2-79); this resulted significantly longer for the 8 EMI patients who undergone allo-HSCT than those (19 patients) who did not receive this procedure (16.7 vs. 8.2 months respectively, p=0.02). Univariate and multivariate analyses showed that undergoing allo-HSCT and achieving CR were the main positive prognostic factors for our population's survival (p<0,0001). This study confirms the poor prognosis for EMI patients. Allo-HSCT, applicable however only in some cases, seems to have a crucial role in these patients' therapeutic approach, being associated with a better prognosis.
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Affiliation(s)
- Luana Fianchi
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
| | - Martina Quattrone
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
| | - Marianna Criscuolo
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
| | - Silvia Bellesi
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
| | - Giulia Dragonetti
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
| | - Alessio Maria Edoardo Maraglino
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
| | - Matteo Bonanni
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
| | - Patrizia Chiusolo
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
| | - Simona Sica
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
| | - Livio Pagano
- Dipartimento di Scienze Radiologiche Radioterapiche ed Ematologiche - Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore
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17
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Shatilova A, Girshova L, Zaytsev D, Budaeva I, Mirolyubova Y, Ryzhkova D, Grozov R, Bogdanov K, Nikulina T, Motorin D, Zammoeva D, Efremova S, Ivanov V, Petukhov A, Alekseeva Y, Zaritskey A. The myeloid sarcoma treated by Venetoclax with hypomethylating agent followed by stem cell transplantation: rare case report. BMC Womens Health 2021; 21:184. [PMID: 33933047 PMCID: PMC8088676 DOI: 10.1186/s12905-021-01328-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Myeloid sarcoma (MS) is a very rare condition, develops both in patients with other hematological neoplasms, and as isolated tumor. MS of the gynecologic tract is extremely rare. An available literature data about diagnosis and management of MS is summarized in the article. The role of chemotherapy, radiation therapy, surgery and bone marrow transplantation in the treatment is discussed. Polychemotherapy and allogeneic bone marrow transplantation were suggested to be the optimal treatment strategy of MS of the gynecological tract. The use of new targeted agents results in promising clinical data. CASE PRESENTATION We are presenting a rare clinical case of a MS of the uterine cervix with concomitant bone marrow involvement and describe all the peculiarities of the clinical course, diagnosis, and treatment. The patient received chemotherapy followed by allogeneic bone marrow transplantation. The pre-transplant therapy allowed us to perform allogeneic bone marrow transplantation with the deepest response possible: complete PET-negative and MRD-negative remission of the disease. CONCLUSIONS MS remains a subject of discussion regarding its diagnostic and therapeutic aspects. The use of novel targeting agents can be perspective option for patient with extramedullary disease.
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Affiliation(s)
- Aleksina Shatilova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341.
| | - Larisa Girshova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Daniil Zaytsev
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Irina Budaeva
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Yuliya Mirolyubova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Darya Ryzhkova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Roman Grozov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Konstantin Bogdanov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Tatiana Nikulina
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Dmitriy Motorin
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Darina Zammoeva
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Svetlana Efremova
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Vladimir Ivanov
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Alexey Petukhov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Yuliya Alekseeva
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
| | - Andrey Zaritskey
- Almazov National Medical Research Centre, 2 Akkuratova Str., Saint Petersburg, Russian Federation, 197341
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18
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Characteristics and transplant outcome of myeloid sarcoma: a single-institute study. Int J Hematol 2021; 113:682-692. [PMID: 33511548 DOI: 10.1007/s12185-021-03081-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
We performed a retrospective study describing the characteristics of myeloid sarcoma (MS) and evaluated the outcome of hematopoietic stem cell transplantation (HSCT) in patients with MS. There were 27 patients with de novo isolated MS, 34 with de novo leukemic MS and 13 with secondary leukemic MS in our study. Sixty-three patients received induction chemotherapy. Following induction therapy, 35 patients underwent HSCT, including 10 autogenous HSCT (auto-HSCT) and 25 allogeneic HSCT (allo-HSCT) cases. Compared with intensive chemotherapy only as consolidation treatment, HSCT (auto-/allo-HSCT) significantly improved the overall survival (OS) of MS patients (p < 0.05), while allo-HSCT also improved progression-free survival (PFS, p = 0.032). According to multivariate analysis, poorer prognosis in terms of OS was observed in older patients (p = 0.024, HR = 1.030, 95% CI 1.004-1.057), while HSCT (auto/allo-HSCT) had a favorable impact on OS for patients with MS (auto-HSCT, p = 0.044, HR = 0.201, 95% CI 0.042-0.959; allo-HSCT, p = 0.038, HR = 0.341, 95% CI 0.124-0.943). Extramedullary disease without complete remission (CR) after induction therapy was the sole variable independent of high OS and PFS (p = 0.049, HR = 2.243, 95% CI: 1.005-5.005; p = 0.017, HR = 2.535, 95% CI 1.180-5.448, respectively). The data indicate that HSCT is an effective treatment for patients with MS who have achieved CR of extramedullary disease after induction therapy.
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Cho BS, Min GJ, Park SS, Park S, Jeon YW, Shin SH, Yahng SA, Yoon JH, Lee SE, Eom KS, Kim YJ, Lee S, Min CK, Cho SG, Kim DW, Wook-Lee J, Kim MS, Kim YG, Kim HJ. Prognostic Impacts of D816V KIT Mutation and Peri-Transplant RUNX1-RUNX1T1 MRD Monitoring on Acute Myeloid Leukemia with RUNX1-RUNX1T1. Cancers (Basel) 2021; 13:cancers13020336. [PMID: 33477584 PMCID: PMC7831332 DOI: 10.3390/cancers13020336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Acute myeloid leukemia (AML) with RUNX1-RUNX1T1 is a heterogeneous disease entailing different prognoses. Patients with high-risk features can benefit from allogeneic hematopoietic stem cell transplantation (HSCT) or autologous HSCT. However, insufficient data about major risk factors, such as KIT mutations and measurable residual disease (MRD) status for relapse, make it difficult to clarify the benefit of each transplant strategy. Moreover, limited data are available to elucidate the exact prognostic impacts of different types of KIT mutations and optimal thresholds or time points for RUNX1–RUNX1T1 MRD assessment, particularly in the setting of HSCT. Given the lack of prospective study, the current retrospective study, including a large cohort of high-risk AML patients with RUNX1–RUNX1T1, firstly demonstrated the differentiated prognostic impact of D816V KIT mutation among various KIT mutations and clarified optimal time points and thresholds for RUNX1–RUNX1T1 MRD monitoring in the setting of HSCT. Abstract The prognostic significance of KIT mutations and optimal thresholds and time points of measurable residual disease (MRD) monitoring for acute myeloid leukemia (AML) with RUNX1-RUNX1T1 remain controversial in the setting of hematopoietic stem cell transplantation (HSCT). We retrospectively evaluated 166 high-risk patients who underwent allogeneic (Allo-HSCT, n = 112) or autologous HSCT (Auto-HSCT, n = 54). D816V KIT mutation, a subtype of exon 17 mutations, was significantly associated with post-transplant relapse and poor survival, while other types of mutations in exons 17 and 8 were not associated with post-transplant relapse. Pre- and post-transplant RUNX1–RUNX1T1 MRD assessments were useful for predicting post-transplant relapse and poor survival with a higher sensitivity at later time points. Survival analysis for each stratified group by D816V KIT mutation and pre-transplant RUNX1–RUNX1T1 MRD status demonstrated that Auto-HSCT was superior to Allo-HSCT in MRD-negative patients without D816V KIT mutation, while Allo-HSCT was superior to Auto-HSCT in MRD-negative patients with D816V KIT mutation. Very poor outcomes of pre-transplant MRD-positive patients with D816V KIT mutation suggested that this group should be treated in clinical trials. Risk stratification by both D816V KIT mutation and RUNX1–RUNX1T1 MRD status will provide a platform for decision-making or risk-adapted therapeutic approaches.
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Affiliation(s)
- Byung-Sik Cho
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Gi-June Min
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Sung-Soo Park
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Silvia Park
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Young-Woo Jeon
- Department of Hematology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Seung-Hwan Shin
- Department of Hematology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Seung-Ah Yahng
- Department of Hematology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Jae-Ho Yoon
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Sung-Eun Lee
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Ki-Seong Eom
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Yoo-Jin Kim
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Seok Lee
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Chang-Ki Min
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Seok-Goo Cho
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
| | - Dong-Wook Kim
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jong Wook-Lee
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
| | - Myung-Shin Kim
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (M.-S.K.); (Y.-G.K.)
| | - Yong-Goo Kim
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (M.-S.K.); (Y.-G.K.)
| | - Hee-Je Kim
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (B.-S.C.); (G.-J.M.); (S.-S.P.); (S.P.); (J.-H.Y.); (S.-E.L.); (K.-S.E.); (Y.-J.K.); (S.L.); (C.-K.M.); (S.-G.C.); (D.-W.K.); (J.-W.L.)
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-2-2258-6054; Fax: +82-2-599-3589
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Shallis RM, Gale RP, Lazarus HM, Roberts KB, Xu ML, Seropian SE, Gore SD, Podoltsev NA. Myeloid sarcoma, chloroma, or extramedullary acute myeloid leukemia tumor: A tale of misnomers, controversy and the unresolved. Blood Rev 2020; 47:100773. [PMID: 33213985 DOI: 10.1016/j.blre.2020.100773] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/01/2020] [Accepted: 10/02/2020] [Indexed: 02/06/2023]
Abstract
The World Health Organization classification and definition of "myeloid sarcoma" is imprecise and misleading. A more accurate term is "extramedullary acute myeloid leukemia tumor (eAML)." The pathogenesis of eAML has been associated with aberrancy of cellular adhesion molecules, chemokine receptors/ligands and RAS-MAPK/ERK signaling. eAML can present with or without synchronous or metachronous intramedullary acute myeloid leukemia (AML) so a bone marrow evaluation is always recommended. Accurate diagnosis of eAML requires tissue biopsy. eAML confined to one or a few sites is frequently treated with local therapy such as radiotherapy. About 75-90% of patients with isolated eAML will develop metachronous intramedullary AML with a median latency period ranging from 4 to 12 months; thus, patients with isolated eAML may also be treated with systemic anti-leukemia therapy. eAML does not appear to have an independent prognostic impact; selection of post-remission therapy including allogeneic hematopoietic cell transplant (alloHCT) is typically guided by intramedullary disease risk. Management of isolated eAML should be individualized based on patient characteristics as well as eAML location and cytogenetic/molecular features. The role of PET/CT in eAML is also currently being elucidated. Improving outcomes of patients with eAML requires further knowledge of its etiology and mechanism(s) as well as therapeutic approaches beyond conventional chemotherapy, ideally in the context of controlled trials.
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Affiliation(s)
- Rory M Shallis
- Section of Hematology, Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, USA
| | - Robert P Gale
- Haematology Section, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kenneth B Roberts
- Department of Radiation Oncology, Yale University School of Medicine, New Haven, USA
| | - Mina L Xu
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Stuart E Seropian
- Section of Hematology, Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, USA
| | - Steven D Gore
- Section of Hematology, Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, USA.
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21
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Hu GH, Lu AD, Jia YP, Zuo YX, Wu J, Zhang LP. Prognostic Impact of Extramedullary Infiltration in Pediatric Low-risk Acute Myeloid Leukemia: A Retrospective Single-center Study Over 10 Years. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e813-e820. [PMID: 32680776 DOI: 10.1016/j.clml.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The impact of extramedullary infiltration (EMI) on the clinical outcomes of pediatric patients with acute myeloid leukemia (AML) are controversial. PATIENTS AND METHODS A total of 214 pediatric patients with low-risk AML were classified as having EMI (central nervous leukemia [CNSL] and/or myeloid sarcoma [MS]) and not having EMI. Patients with isolated MS before AML diagnosis by bone marrow examination were confirmed with histopathologic examination. For patients diagnosed with AML by bone marrow examination, a thorough physical examination and radiologic imaging were used to confirm MS. RESULTS Male gender, a high white blood cell count, the FAB-M5 subtype, t(8;21) and t(1;11) abnormalities, and c-KIT mutations were associated with EMI. The presence of MS was associated with a low complete remission rate (63.6% vs. 79.4%; P = .000) and poor 3-year relapse-free survival (RFS) (62.6% ± 7.5% vs. 87.0% ± 2.8%; P = .000) and 3-year overall survival (73.5% ± 7% vs. 88.8% ± 2.6%; P = .011). Multivariate analysis revealed that MS was a poor prognostic factor for RFS and overall survival. Bone infiltration was an independent risk factor for inferior RFS with MS. Patients with CNSL had a low complete remission rate (58.3% vs. 77.2%; P = .045); however, CNSL did not significantly affect the survival of low-risk patients with AML. CONCLUSION MS should be considered an independent risk factor to guide stratified treatment.
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Affiliation(s)
- Guan-Hua Hu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Ai-Dong Lu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Yue-Ping Jia
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Ying-Xi Zuo
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Jun Wu
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China
| | - Le-Ping Zhang
- Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China.
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Bakst R, Powers A, Yahalom J. Diagnostic and Therapeutic Considerations for Extramedullary Leukemia. Curr Oncol Rep 2020; 22:75. [PMID: 32577912 DOI: 10.1007/s11912-020-00919-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current literature on the presentation, diagnosis, and treatment options available for extramedullary (EM) manifestations of leukemia including myeloid sarcoma (MS) and leukemia cutis (LC). RECENT FINDINGS Advanced imaging using 18FDG-PET/CT is an effective screening tool for EM manifestations of leukemia. The role of radiation therapy has been more clearly delineated in the treatment of both MS and LC. FDA-approved targeted agents have improved outcomes in patients with AML but have not demonstrated improvements specifically for EM; however, a checkpoint inhibitor, Ipilimumab, holds promise in impacting local control for the treatment of AML-related EM. EM manifestations of leukemia pose significant therapeutic challenges. Treatment of EM is predicated on multiple factors including the presence of concomitant bone marrow involvement, AML-risk classification, and timing of presentation at initial diagnosis or relapse following systemic therapy.
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Affiliation(s)
- Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY, 10029, USA.
| | - Ann Powers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kunadt D, Kramer M, Dill C, Altmann H, Wagenführ L, Mohr B, Thiede C, Röllig C, Schetelig J, Bornhäuser M, Schaich M, Stölzel F. Lysyl oxidase expression is associated with inferior outcome and Extramedullary disease of acute myeloid leukemia. Biomark Res 2020; 8:20. [PMID: 32537166 PMCID: PMC7291659 DOI: 10.1186/s40364-020-00200-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/05/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lysyl oxidase (LOX) has been described as necessary for premetastatic niche formation in epithelium-derived malignancies and its expression level therefore correlates with risk of metastatic disease and overall survival. However, its role in acute myeloid leukemia (AML) has not been sufficiently analyzed. METHODS We investigated LOX plasma expression in 683 AML patients (age 17-60 years) treated within the prospective AML2003 trial (NCT00180102). The optimal cut-off LOX value was determined using a minimal-p-value method dichotomizing patients into a LOX-high group (> 109 ng/mL, n = 272, 40%) and a LOX-low group (≤ 109 ng/mL, n = 411, 60%). RESULTS Higher LOX expression was associated with lower peripheral white blood cells, lower serum LDH, and a lower frequency of FLT3-ITD and NPM1 mutations at diagnosis. Higher LOX expression was found significantly more frequently in patients with secondary AML and therapy-related AML, in patients with French-American-British M5 subtypes, and in patients with adverse-risk cytogenetics. Comparing patients in the LOX-high group and the LOX-low group revealed a 3-year overall survival (OS) of 47 and 53% (p = 0.022) and 3-year event-free survival (EFS) of 27 and 35% (p = 0.005), respectively. In the LOX-high group significantly more patients had extramedullary AML compared to the LOX-low group (p = 0.037). Combining extramedullary AML and LOX as interacting factors in a multivariate analysis resulted in an independent impact on survival for the LOX-high-extramedullary interaction for OS (HR = 2.25, p = 0.025) and EFS (HR = 2.48, p = 0.008). Furthermore, in patients with extramedullary disease (n = 59) the LOX level predicted survival. Patients within the LOX-low group had an OS of 43% and EFS of 36% as compared to the LOX-high group with an OS of 13% and EFS of 6% (p = 0.002 and p = 0.008, respectively). CONCLUSION We hypothesize LOX expression to be a new potential biomarker to predict outcome in AML, specifically in AML subgroups such as the prognostic heterogeneous group of AML patients with extramedullary disease. TRIAL REGISTRATION This retrospective study was performed with patient samples registered within the prospective AML2003 trial (NCT00180102). Patients were enrolled between December 2003 and November 2009.
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Affiliation(s)
- Desiree Kunadt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Michael Kramer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Claudia Dill
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Heidi Altmann
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Lisa Wagenführ
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Brigitte Mohr
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Markus Schaich
- Department of hematology, oncology and palliative care, Rems-Murr-Klinikum, Winnenden, Germany
| | - Friedrich Stölzel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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Myeloid Sarcomas Causing Unilateral Cranial Nerve Palsies in a Patient with Relapsed Acute Myeloblastic Leukemia. Case Rep Hematol 2020; 2020:3749565. [PMID: 32509360 PMCID: PMC7201833 DOI: 10.1155/2020/3749565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/06/2019] [Indexed: 12/17/2022] Open
Abstract
Myeloid sarcomas (MS) are a rare manifestation of myeloid malignancies and can often be misdiagnosed, leading to a delay in treatment. The objective of this clinical case is to highlight the challenges of the clinical presentation and to emphasize the importance of this manifestation ensuring timely diagnosis and therapy. Here, we present a 43-year-old man who was diagnosed with acute myeloblastic leukemia (AML) after being evaluated for unintentional weight loss, subcutaneous nodules, thrombocytopenia, and anemia. The patient underwent chemotherapy with complete remission and presented 4 months later with dysphagia and cranial nerve palsies. Appropriate imaging and biopsy led to a diagnosis of myeloid sarcoma, and a decision was made to begin reinduction chemotherapy for AML achieving a second complete remission although his neurological deficits did not improve. Our case illustrates the protean presentation of myeloid sarcomas; clinicians should have a high suspicion for MS and remain vigilant when unexplained signs and symptoms arise in the background of a myeloid malignancy although challenges still remain when presentation is de novo. Advancements in understanding the pathophysiology of MS have been performed but remain not completely understood. High clinical suspicion, appropriate imaging, biopsy techniques, and expertise are paramount for timely diagnosis and treatment.
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Abstract
PURPOSE OF REVIEW Myeloid sarcoma; also known as granulocytic sarcoma and chloroma, often occurs concomitantly with AML, and rarely without bone marrow involvement. In this article, we review the recent literature on myeloid sarcoma, focusing on treatment approach for this rare disease, and addressing the prognostic and therapeutic role of molecular and cytogenetic aberrations. RECENT FINDINGS Molecular testing and cytogenetics are important adjunct to conventional diagnostic methods. The significance of cytogenetic and molecular abnormalities in myeloid sarcoma is not completely established, but testing for targetable mutations on myeloid sarcoma cells is feasible, imperative, and may guide treatment decisions. Outcomes in myeloid sarcoma largely depend on the background of its development. Almost all patients with myeloid sarcoma eventually develop AML typically in a short period after its diagnosis; therefore, remission induction treatment using AML type chemotherapy has been the standard of care. Postremission therapy is controversial; allogenic SCT, radiotherapy or consolidation chemotherapy should be considered according to patient risk. SUMMARY Further research is required to understand the nature of myeloid sarcoma, and inclusion of patients with this condition in clinical trials should be considered to better identify the best diagnostic, prognostic, and therapeutic approach in managing this rare disease.
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Slouma M, Rahmouni S, Dhahri R, Khayati Y, Zriba S, Amorri W, Gharsallah I, Metoui L, Louzir B. Epidural myeloid sarcoma as the presenting symptom of chronic myeloid leukemia blast crisis. Clin Rheumatol 2020; 39:2453-2459. [PMID: 32458246 DOI: 10.1007/s10067-020-05167-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 02/03/2023]
Abstract
Epidural myeloid sarcoma revealing chronic myeloid leukemia is scarce. Herein, we describe a patient that presented with back pain and bilateral sciatica secondary to root compression due to epidural deposition of leukemic cells. The magnetic resonance imaging showed epidural masses, causing a slight restriction of the spinal canal with bilateral L5 root compression. Laboratory examinations showed hyperleukocytosis (white blood cell count: 83 × 109/L, absolute neutrophil count: 60 × 109/L). The bone marrow cytology and immunophenotypic findings confirmed the diagnosis of myeloid leukemia. The diagnosis of spinal myeloid sarcoma revealing chronic myeloid leukemia during the blast phase was established. The patient underwent induction chemotherapy. Then, bone marrow cytology revealed less than 3% of blasts, which correspond to cytological remission. Three months later, MRI showed complete disappearance of the epidural masses. A literature review was conducted by searching PubMed using these terms: "Leukemia, Myeloid" AND "Spine" AND "Sarcoma, Myeloid". We emphasize clinical and radiological findings of spinal myeloid sarcoma. This diagnosis should be considered when the MRI reveals epidural mass lesion. The early management of this disease is necessary, and the treatment of myeloid sarcoma is not codified. Our case highlighted that chemotherapy treatment could be sufficient to lead to the disappearance of myeloid sarcoma and the remission of leukemia.
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Affiliation(s)
- Maroua Slouma
- Department of Internal Medicine, Military Hospital, Tunis El Manar University, Tunis, Tunisia.
| | - Safa Rahmouni
- Department of Internal Medicine, Military Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Rim Dhahri
- Department of Internal Medicine, Military Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Yasmine Khayati
- Department of Internal Medicine, Military Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Samy Zriba
- Department of Hematology, Military Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Wajdi Amorri
- Department of Radiology, Military Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Imen Gharsallah
- Department of Internal Medicine, Military Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Leila Metoui
- Department of Internal Medicine, Military Hospital, Tunis El Manar University, Tunis, Tunisia
| | - Bassem Louzir
- Department of Internal Medicine, Military Hospital, Tunis El Manar University, Tunis, Tunisia
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Barbieri FR, De Luna A, Moschettoni L, Lunardi P. Isolated intracranial myeloid sarcoma: report of a case and review of the literature. Br J Neurosurg 2020:1-4. [PMID: 32351132 DOI: 10.1080/02688697.2020.1759782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Myeloid sarcoma is a rare malignant tumor of primitive myeloid cell origin often associated with hematologic disorders. The central nervous system is rarely involved and differentiating between myeloid sarcoma and other tumors is not possible on imaging. Here we present the rare case of an isolated intracranial myeloid sarcoma, initially misdiagnosed radiologically as a meningioma, treated with surgical total resection and subsequent chemotherapy, with no signs of any hematological disorder at follow up. Differential diagnosis and management strategies, as well as follow-up implications are discussed along with literature review, which pointed out that only five cases with no further signs of hematological disorders at follow up have been described in the literature so far and this case has the longest follow up of them at 9 years.
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Affiliation(s)
| | - Adolfo De Luna
- Department of Neurosurgery, Policlinico Tor Vergata, Rome, Italy
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Xu LH, Wang Y, Chen ZY, Fang JP. Myeloid sarcoma is associated with poor clinical outcome in pediatric patients with acute myeloid leukemia. J Cancer Res Clin Oncol 2020; 146:1011-1020. [PMID: 31919567 DOI: 10.1007/s00432-020-03128-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/06/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE The impact of myeloid sarcoma (MS) on clinical outcome of pediatric acute myeloid leukemia (AML) patients remains controversial. Moreover, little is known about the role of stem cell transplantation (SCT) in such patients. METHODS Clinical data of patients with AML under 18 years of age were retrieved from the TARGET dataset. We analyzed the prevalence, clinical profile, molecular characteristics, and prognosis of MS in these patients. RESULTS Among 884 pediatric patients with AML, the frequency of MS was 12.3%. Pediatric AML with MS was associated with age under 1-year, abnormal cytogenetics, and KMT2A rearrangement. Moreover, MS was associated with a low complete remission rate, high induction death, poor 5-year EFS, and OS. KMT2A rearrangement had a negative impact on clinical outcome in AML patients with MS. In addition, SCT had no significant effect on the survival of AML patients with MS. Multivariate analysis revealed that MS was an unfavorable prognostic factor in pediatric AML in terms of EFS (Hazard ratio 1.670, P < 0.001) and OS (Hazard ratio 1.623, P = 0.004). CONCLUSIONS The presence of MS at diagnosis of pediatric AML is associated with poor clinical outcomes, particularly when associated with KMT2A rearrangements. Moreover, pediatric patients with AML and MS may not benefit from SCT.
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Affiliation(s)
- Lu-Hong Xu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107, West Yan Jiang Road, Guangzhou, Guangdong Province, People's Republic of China.
| | - Yin Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107, West Yan Jiang Road, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhi-Yuan Chen
- Department of Pulmonary, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jian-Pei Fang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107, West Yan Jiang Road, Guangzhou, Guangdong Province, People's Republic of China.
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Prem S, Atenafu EG, Avena J, Bautista R, Law A, Lam W, Michelis FV, Kim DDH, Viswabandya A, Lipton JH, Mattsson J, Kumar R. Impact of central nervous system involvement in AML on outcomes after allotransplant and utility of pretransplant cerebrospinal fluid assessment. Eur J Haematol 2019; 103:483-490. [DOI: 10.1111/ejh.13314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Shruti Prem
- Princess Margaret Cancer Centre University of Toronto Toronto ON Canada
| | - Eshetu G. Atenafu
- Princess Margaret Cancer Centre University of Toronto Toronto ON Canada
| | - Jose Avena
- Princess Margaret Cancer Centre University of Toronto Toronto ON Canada
| | - Rhida Bautista
- Princess Margaret Cancer Centre University of Toronto Toronto ON Canada
| | - Arjun Law
- Princess Margaret Cancer Centre University of Toronto Toronto ON Canada
| | - Wilson Lam
- Princess Margaret Cancer Centre University of Toronto Toronto ON Canada
| | | | | | - Auro Viswabandya
- Princess Margaret Cancer Centre University of Toronto Toronto ON Canada
| | | | - Jonas Mattsson
- Princess Margaret Cancer Centre University of Toronto Toronto ON Canada
| | - Rajat Kumar
- Princess Margaret Cancer Centre University of Toronto Toronto ON Canada
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An Unusual Cause of Epistaxis: Paranasal Sinus Myeloid Sarcoma. Case Rep Hematol 2019; 2019:1312630. [PMID: 30891319 PMCID: PMC6390259 DOI: 10.1155/2019/1312630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/24/2019] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 65-year-old female who presented with right-sided headaches, blurring of vision in the right eye, cold-induced epistaxis, and facial numbness in the trigeminal nerve distribution. Laboratory studies revealed a significant number of myeloblasts on peripheral smear with granulated cytoplasm, irregular nuclei, and prominent vacuoles. Magnetic resonance imaging (MRI) of the brain demonstrated a T1-enhancing 1.5 cm right-sided dural-based lesion involving the medial sphenoid wing, cavernous sinus, infratemporal fossa, and sphenoid sinus region. An endoscopic biopsy of the lesion within the sphenoid sinus confirmed the diagnosis of myeloid sarcoma, with myeloblasts comprising 30% of cellularity by flow cytometry. A subsequent bone marrow biopsy revealed a hypercellular marrow with 23% blasts by flow cytometry that demonstrated a similar immunophenotypic pattern to those seen in the sinus mass. Fluorescence in situ hybridization (FISH) testing revealed the balanced translocation t(8;21)(q22;q22.1), consistent with a diagnosis of acute myeloid leukemia with RUNX1-RUNX1T1-balanced translocation by WHO 2016 criteria. Myeloid sarcoma represents a rare extramedullary presentation of acute myeloid leukemia (AML), either alone or in conjunction with blood or bone marrow involvement. This case emphasizes the need for a broad differential diagnosis and an aggressive work-up for any unusual paranasal sinus mass.
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Multiple Granulocytic Sarcomas: A Rare Presentation of Acute Myeloid Leukemia. Indian J Hematol Blood Transfus 2018; 35:186-188. [PMID: 30828173 DOI: 10.1007/s12288-018-1033-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 10/16/2018] [Indexed: 12/28/2022] Open
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Myeloid Sarcoma Predicts Superior Outcome in Pediatric AML; Can Cytogenetics Solve the Puzzle? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e249-e254. [DOI: 10.1016/j.clml.2018.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/13/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022]
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Obayashi O, Obata H, Naito K, Kanda A, Itoi A, Morohashi I, Mogami A, Kaneko K. Recurrence of acute myelogenous leukemia with granulocytic sarcoma-associated tarsal tunnel syndrome in an elderly patient. J Orthop Sci 2018; 23:596-599. [PMID: 27452740 DOI: 10.1016/j.jos.2016.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 06/19/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Osamu Obayashi
- Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan.
| | - Hiroyuki Obata
- Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan
| | - Kiyohito Naito
- Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan
| | - Akio Kanda
- Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan
| | - Akira Itoi
- Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan
| | - Itaru Morohashi
- Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan
| | - Atsuhiko Mogami
- Department of Orthopedic Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University School of Medical, Tokyo, Japan
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Kawamoto K, Miyoshi H, Suzuki T, Kiyasu J, Yokoyama S, Sasaki Y, Sone H, Seto M, Takizawa J, Ohshima K. Expression of programmed death ligand 1 is associated with poor prognosis in myeloid sarcoma patients. Hematol Oncol 2018; 36:591-599. [PMID: 29602174 DOI: 10.1002/hon.2506] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/26/2018] [Accepted: 02/11/2018] [Indexed: 12/19/2022]
Abstract
Myeloid sarcoma (MS) is a rare condition and is an extramedullary tumour of immature myeloid cells. It is now known that the programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) pathway suppresses the host antitumor responses and that these products are expressed on both tumour cells and tumour-infiltrating cells in various malignancies. However, little is known about the significance of PD-1/PD-L1 expression on tumour cells and tumour microenvironmental cells in MS. To investigate the clinicopathological significance of PD-1/PD-L1 expression in MS, we analyzed 98 patients by immunohistochemistry. Of these, 10.2% of cases had neoplastic tumour cells positive for PD-L1 (nPD-L1+ ). However, the rate of nPD-L1+ was <5% (range: 0.27 to 2.97%). On the other hand, PD-L1 expression on 1 or more of stromal cells in the tumour microenvironment (miPD-L1+ ) was observed in 37.8% of cases. Because all nPD-L1+ cases expressed PD-1 on less than 5% of tumour cells, we compared the miPD-L1+ and miPD-L1- groups. There was a correlation between miPD-L1+ status and the number of PD-1-expressing tumour -infiltrating lymphocytes (PD-1+ TILs; P = .0229). miPD-L1+ was found to be associated with poorer overall survival and progression-free survival (P = .00392, P = .00261, respectively). Multivariate analysis also confirmed miPD-L1+ to be an independent poor prognostic factor. In conclusion, our study indicated that the immunotherapy blocking the PD-1/PD-L1 pathway may improve the clinical outcome of MS.
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Affiliation(s)
- Keisuke Kawamoto
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan.,Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Takaharu Suzuki
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Junichi Kiyasu
- Department of Hematology, Iizuka Hospital, Iizuka, Japan
| | - Shintaro Yokoyama
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Yuya Sasaki
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Masao Seto
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
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Tokunaga K, Yamamura A, Ueno S, Kikukawa Y, Yamaguchi S, Hidaka M, Matsuno N, Kawaguchi T, Matsuoka M, Okuno Y. Isolated Pancreatic Myeloid Sarcoma Associated with t(8;21)/RUNX1-RUNX1T1 Rearrangement. Intern Med 2018; 57:563-568. [PMID: 29151502 PMCID: PMC5849554 DOI: 10.2169/internalmedicine.8912-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
No valid treatment for isolated myeloid sarcoma (IMS) has yet been established, and no thorough genetic examinations have been performed because of its low incidence and unique manner of development. We herein report a 34-year-old man with pancreatic IMS with t(8;21)/RUNX1-RUNX1T1 rearrangement. He was treated with high-dose cytarabine followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). This is the first report of pancreatic IMS with t(8;21). Positron emission tomography/computed tomography and genetic study are useful for the diagnosis, and allo-HSCT achieved complete remission in this patient.
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Affiliation(s)
- Kenji Tokunaga
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Ayako Yamamura
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Shikiko Ueno
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Yoshitaka Kikukawa
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Shunichiro Yamaguchi
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Japan
| | - Naofumi Matsuno
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Tatsuya Kawaguchi
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Masao Matsuoka
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
| | - Yutaka Okuno
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Japan
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Yu G, Yin C, Jiang L, Xu D, Zheng Z, Wang Z, Wang C, Zhou H, Jiang X, Liu Q, Meng F. Amyloid precursor protein has clinical and prognostic significance in AML1-ETO-positive acute myeloid leukemia. Oncol Lett 2017; 15:917-925. [PMID: 29399155 PMCID: PMC5772886 DOI: 10.3892/ol.2017.7396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/21/2017] [Indexed: 01/15/2023] Open
Abstract
Amyloid precursor protein (APP) has been reported to be highly expressed in acute myeloid leukemia (AML)1-eight-twenty one (ETO)-positive AML. In the present study, the clinical and prognostic significance of APP expression was assessed in 65 patients with AML1-ETO-positive AML using reverse transcription-quantitative polymerase chain reaction. The patients were divided into an APP-high expression (APP-H) group (n=32) and an APP-low expression (APP-L) group (n=33) according to the cut-off value of APP relative expression, which was calculated by receiver operating characteristic curve analysis. It was observed that C-KIT mutations (14/32 vs. 3/33, P=0.009), white blood cell count (median, 23.2×109 vs. 12.4×109 cells/l; P=0.011) and bone marrow cellularity (median, 91.0 vs. 84.0%; P=0.039) and incidence of extramedullary leukemia (11/32 vs. 3/33, P=0.013) were all significantly increased in the APP-H group compared with the APP-L group. Furthermore, significantly lower rate of cumulative two-cycle complete remission (83.9 vs. 100%, P=0.016), major molecular remission following two courses of consolidation (34.5 vs. 71.4%, P=0.005), and poorer relapse-free survival (RFS) (33.5±5.2% vs. 76.3±6.9%, P<0.001) and overall survival (OS) (44.5±7.0% vs. 81.9±5.8%, P=0.002) were associated with APP overexpression. Multivariate analysis revealed that APP overexpression was a significant adverse factor affecting both RFS and OS. Taken together, these data suggest that APP may be correlated with C-KIT mutations and involved in leukemia cell proliferation, and its overexpression has an adverse effect on the prognosis in AML1-ETO-positive AML.
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Affiliation(s)
- Guopan Yu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Changxin Yin
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Ling Jiang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Dan Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Zhongxin Zheng
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Zhixiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Chunli Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Hongsheng Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Xuejie Jiang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Fanyi Meng
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China.,Hematopathy Diagnosis and Therapy Center, Kanghua Hospital, Dongguan, Guangdong 523000, P.R. China
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Ganzel C, Manola J, Douer D, Rowe JM, Fernandez HF, Paietta EM, Litzow MR, Lee JW, Luger SM, Lazarus HM, Cripe LD, Wiernik PH, Tallman MS. Extramedullary Disease in Adult Acute Myeloid Leukemia Is Common but Lacks Independent Significance: Analysis of Patients in ECOG-ACRIN Cancer Research Group Trials, 1980-2008. J Clin Oncol 2017; 34:3544-3553. [PMID: 27573652 DOI: 10.1200/jco.2016.67.5892] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Extramedullary disease (EMD) at diagnosis in patients with acute myeloid leukemia (AML) has been recognized for decades. Reported herein are results from a large study of patients with AML who were treated in consecutive ECOG-ACRIN Cancer Research Group frontline clinical trials in an attempt to define the incidence and clinical implications of EMD. Methods Patients with newly diagnosed AML, age 15 years and older, who were treated in 11 clinical trials, were studied to identify EMD, as defined by physical examination, laboratory findings, and imaging results. Results Of the 3,522 patients enrolled, 282 were excluded, including patients with acute promyelocytic leukemia, incorrect diagnosis, or no adequate assessment of EMD at baseline. The overall incidence of EMD was 23.7%. The sites involved were: lymph nodes (11.5%), spleen (7.3%), liver (5.3%), skin (4.5%), gingiva (4.4%), and CNS (1.1%). Most patients (65.3%) had only one site of EMD, 20.9% had two sites, 9.5% had three sites, and 3.4% had four sites. The median overall survival was 1.035 years. In univariable analysis, the presence of any EMD ( P = .005), skin involvement ( P = .002), spleen ( P < .001), and liver ( P < .001), but not CNS ( P = .34), nodal involvement ( P = .94), and gingival hypertrophy ( P = .24), was associated with a shorter overall survival. In contrast, in multivariable analysis, adjusted for known prognostic factors such as cytogenetic risk and WBC count, neither the presence of EMD nor the number of specific sites of EMD were independently prognostic. Conclusion This large study demonstrates that EMD at any site is common but is not an independent prognostic factor. Treatment decisions for patients with EMD should be made on the basis of recognized AML prognostic factors, irrespective of the presence of EMD.
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Affiliation(s)
- Chezi Ganzel
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Judith Manola
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Dan Douer
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Jacob M Rowe
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Hugo F Fernandez
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Elisabeth M Paietta
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Mark R Litzow
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Ju-Whei Lee
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Selina M Luger
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Hillard M Lazarus
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Larry D Cripe
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Peter H Wiernik
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Martin S Tallman
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
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Bourlon C, Lipton JH, Deotare U, Gupta V, Kim DD, Kuruvilla J, Viswabandya A, Thyagu S, Messner HA, Michelis FV. Extramedullary disease at diagnosis of AML does not influence outcome of patients undergoing allogeneic hematopoietic cell transplant in CR1. Eur J Haematol 2017; 99:234-239. [PMID: 28556258 DOI: 10.1111/ejh.12909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Extramedullary disease (EMD) at diagnosis of acute myeloid leukemia (AML) has been associated with increased risk of relapse and worse outcomes post-chemotherapy. This study sought to investigate the association of EMD with outcomes following allogeneic hematopoietic cell transplantation (allo-HCT). METHODS This single-center retrospective study investigated the impact of EMD at diagnosis on the outcome of patients transplanted for AML in first complete remission (CR1). The study included 303 consecutive patients with AML transplanted in CR1, median age 51 years (range 18-71). RESULTS EMD at diagnosis was documented in 39 patients (13%), either histologically (26 patients) or clinically/radiologically (13 patients). Among the 39 EMD patients, 16 had CNS disease, seven had gingival infiltration, and five had leukemia cutis. On univariate analysis, EMD had no significant impact on survival, with a 3-year OS of 55% (95% CI 38-69) compared to 48% for the non-EMD group (95% CI 42%-55%) (P=.84). Likewise, 3-year CIR was 18% vs 19% (P=.86) and 3-year NRM was 26% vs 33% (P=.83) for EMD vs non-EMD groups, respectively. Multivariate analysis confirmed these results. CONCLUSIONS We conclude that EMD at diagnosis of AML does not seem to influence outcomes following allo-HCT performed in CR1.
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Affiliation(s)
- Christianne Bourlon
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey H Lipton
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Uday Deotare
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Vikas Gupta
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dennis D Kim
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Kuruvilla
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Auro Viswabandya
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Santhosh Thyagu
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hans A Messner
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fotios V Michelis
- Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Kaur V, Swami A, Alapat D, Abdallah AO, Motwani P, Hutchins LF, Jethava Y. Clinical characteristics, molecular profile and outcomes of myeloid sarcoma: a single institution experience over 13 years. ACTA ACUST UNITED AC 2017; 23:17-24. [PMID: 28574302 DOI: 10.1080/10245332.2017.1333275] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Myeloid sarcoma (MS) is characterized by extramedullary infiltration by immature myeloid cells. Owing to rarity of this disease, the clinical features and overall outcomes are yet to be clarified. OBJECTIVE To define clinical characteristics, epidemiology, pathologic findings, treatment options and outcomes in MS. METHODS We conducted a retrospective review of 23 patients diagnosed with MS at our institute over a period of 13 years (2002-2015). RESULTS MS presented mostly as a manifestation of relapsed acute myeloid leukemia, seen in 39% of patients. Skin and subcutaneous soft tissues were the most common sites of anatomic involvement (69.5%). Ninety five percent (n = 19) were positive for classical myeloid markers with either cytochemical staining (chloracetate-esterase, MPO), flow-cytometry (CD33, CD34, CD13 and CD117), or immunohistochemistry (CD34, CD43, CD68 and lysozyme). Of these, 52% were positive for CD33 (n = 12), 35% for CD68 (n = 8), 30% for CD34 (n = 7), and 26% for lysozyme (n = 6). Cytogenetic abnormalities were seen in 63% (n = 12/19) patients on bone-marrow aspirate, with five patients displaying a complex (n = 3) or monosomal (n = 2) karyotype. Twenty seven percent patients with a normal karyotype had presence of deleterious mutations (FLT3, ASXL, STAG and JAK2) on further testing with myeloid mutation panel. The Median overall survival (OS) of the entire cohort was 15.9 months (95% CI, 7.4-24.4 months). The OS was significantly better for patients <65 years (24.6 vs. 3.4 months, p = 0.009) of age, and for those attaining a complete remission (CR) to induction therapy (25.7 vs. 0.8 months, p < 0.001). All patients who underwent allogeneic hematopoietic stem cell transplant attained long-term remissions, with a median follow-up of 54 (range 32-120) months. CONCLUSION Failure to achieve CR with induction therapy, and age >65 years are associated with poor outcomes in MS. Allogeneic stem-cell transplant in first remission appears to be the most effective modality for achieving long-term remissions.
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Affiliation(s)
- Varinder Kaur
- a Department of Medicine, Division of Hematology and Oncology, Emily Couric Cancer Center , University of Virginia , Charlottesville , VA , USA.,b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Arjun Swami
- c Government Medical College , Chandigarh , India
| | - Daisy Alapat
- d Department of Pathology , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Al Ola Abdallah
- b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA.,e Department of Hematology and Oncology , University of Kansas Medical Center , Kansas City , KS , USA
| | - Pooja Motwani
- b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Laura F Hutchins
- b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Yogesh Jethava
- b Division of Hematology and Oncology , Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , AR , USA
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40
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ASXL2 is essential for haematopoiesis and acts as a haploinsufficient tumour suppressor in leukemia. Nat Commun 2017; 8:15429. [PMID: 28516957 PMCID: PMC5454368 DOI: 10.1038/ncomms15429] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/29/2017] [Indexed: 12/22/2022] Open
Abstract
Additional sex combs-like (ASXL) proteins are mammalian homologues of additional sex combs (Asx), a regulator of trithorax and polycomb function in Drosophila. While there has been great interest in ASXL1 due to its frequent mutation in leukemia, little is known about its paralog ASXL2, which is frequently mutated in acute myeloid leukemia patients bearing the RUNX1-RUNX1T1 (AML1-ETO) fusion. Here we report that ASXL2 is required for normal haematopoiesis with distinct, non-overlapping effects from ASXL1 and acts as a haploinsufficient tumour suppressor. While Asxl2 was required for normal haematopoietic stem cell self-renewal, Asxl2 loss promoted AML1-ETO leukemogenesis. Moreover, ASXL2 target genes strongly overlapped with those of RUNX1 and AML1-ETO and ASXL2 loss was associated with increased chromatin accessibility at putative enhancers of key leukemogenic loci. These data reveal that Asxl2 is a critical regulator of haematopoiesis and mediates transcriptional effects that promote leukemogenesis driven by AML1-ETO. While the role of ASLX1 in haematopoiesis and leukaemia has been heavily studied, the role of ASLX2 is unclear. Here the authors show that ASLX2 is required for normal haematopoietic stem cell self-renewal whereas Asxl2 loss promotes leukemogenesis, thus explaining the frequently observed mutations in AML patients
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41
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Chernova NG, Sinicyna MN, Dvirnyk VN, Kovrigina AM, Zvonkov EE, Parovichnikova EN. Skin lesion at acute monoblastic leukemia (clinical observation). VESTNIK DERMATOLOGII I VENEROLOGII 2017. [DOI: 10.25208/0042-4609-2017-93-1-46-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
At present diagnosis of acute leukemia does not represent any difficulties and is based on morphological and immunophenotypical bone marrow studies. The paper presents a non-standard verification algorithm of acute monoblastic leukemia in elderly female patient, with leukemic skin lesion. Morphologic and immunohistochemical studies of biopsy materials of skin, lymph node and bone marrow allow establishing a linear membership of tumor cells and promptly verifying the diagnosis of leukemia. Lack of the overall clinical examination in such cases leads to diagnostic errors and to late verification of the true diagnosis and significantly worsens the prognosis.
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42
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Chandra P, Dhake S, Purandare N, Agrawal A, Shah S, Rangarajan V. Role of FDG PET/CT in Diagnostic Evaluation of Granulocytic Sarcomas: A Series of 12 Patients. Indian J Nucl Med 2017; 32:198-202. [PMID: 28680203 PMCID: PMC5482015 DOI: 10.4103/ijnm.ijnm_10_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Granulocytic sarcoma (GS) is a rare extramedullary manifestation in patients with acute myeloid leukemia (AML), which can precede the diagnosis or occur in the posttreatment setting. Unlike its established role in other hematological malignancies like Hodgkin's on non-Hodgkin's disease, the exact role of positron emission tomography/computed tomography (PET/CT) in AML with or without GS remains to be defined. MATERIALS AND METHODS We retrospectively reviewed PET/CT scans of 12 patients with histologically proven GS. Marrow examination of these patients identified nine patients with isolated GS (without existent leukemia) and three patients with coexistent leukemia. RESULTS PET/CT accurately identified all clinically evident GS in all 12 patients at initial staging and at follow-up with tumors, showing moderate to high 2-deoxy-2-fluoro-D-glucose uptake. Coexistent marrow disease was seen on PET/CT in three patients, which was confirmed on histopathology. In the same patients, PET/CT also detected additional sites of extramedullary disease in 66.6% (n = 8), which was either clinically occult or not evident on routine CT. CONCLUSION PET/CT appears to be a highly sensitive imaging modality in diagnostic evaluation of GS. The most important indication of using PET/CT in these cases is to identify additional sites of clinically occult extramedullary disease, which can potentially impact treatment decisions and outcomes.
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Affiliation(s)
- Piyush Chandra
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sanket Dhake
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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43
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Ohanian M, Pemmaraju N, Rozovski U, Alattar ML, Estrov Z, Kundra V, Tung C, Ravandi F, Manning J, Abruzzo LV. Ocular extramedullary myeloid leukaemia. Br J Haematol 2016; 180:738-740. [PMID: 27879987 DOI: 10.1111/bjh.14430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Maro Ohanian
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Uri Rozovski
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mona L Alattar
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Zeev Estrov
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Vikas Kundra
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Cynthia Tung
- Department of Ophthalmology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - John Manning
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Lynne V Abruzzo
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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44
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Park SS, Yoon JH, Kim HJ, Jeon YW, Lee SE, Cho BS, Eom KS, Kim YJ, Lee S, Min CK, Cho SG, Kim DW, Lee JW, Min WS. Characteristics and Survival Outcome Analysis of Extramedullary Involvement in Adult Patients With t(8;21) Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 17:38-45.e2. [PMID: 27742476 DOI: 10.1016/j.clml.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) with t(8;21)(q22;q22) is classified into a favorable-risk group. Extramedullary (EM) involvement has frequently been reported in this subgroup as resulting in a poor prognosis. However, characteristics or standard treatments of t(8;21) AML with EM involvement (EM-positive t(8;21)) have not yet been elucidated. PATIENTS AND METHODS We retrospectively analyzed 154 adult AML patients with t(8;21). Among them, 17 were EM positive and 137 were EM negative at the time of diagnosis. EM involvement was evaluated only when a patient showed suspicious signs or symptoms. All EM-positive patients were treated according to a strategy based on allogeneic hematopoietic cell transplantation (allo-HCT). RESULTS Central nervous system was the most frequently involved site (70.6%). EM-positive t(8;21) was associated with age ≤ 45 years, leukocytosis (≥ 30 × 109/L), and c-kit mutation compared to EM-negative t(8;21) in multivariate analysis. After intensive chemotherapy with or without local therapy, high-risk t(8;21) AML including EM-positive t(8;21) underwent allo-HCT for postremission therapy. Three-year OS (52.3% vs. 60.0%, P = .658) and event-free survival (51.5% vs. 58.0%, P = .496) were not different between the 2 groups. The subgroup of patients who underwent allo-HCT also showed similar outcomes. CONCLUSION EM-positive t(8;21) was associated with young age, leukocytosis, and c-kit mutation, and central nervous system was frequently involved. Allo-HCT resulted in good outcomes in EM-positive t(8;21).
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Affiliation(s)
- Sung-Soo Park
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Ho Yoon
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Young-Woo Jeon
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Eun Lee
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Sik Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Seong Eom
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo-Jin Kim
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Lee
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok-Goo Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Wook Kim
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Wook Lee
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo-Sung Min
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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45
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Massoud M, Del Bufalo F, Caterina Musolino AM, Schingo PM, Gaspari S, Pisani M, Orazi C, Reale A, Raucci U. Myeloid Sarcoma Presenting as Low Back Pain in the Pediatric Emergency Department. J Emerg Med 2016; 51:308-14. [DOI: 10.1016/j.jemermed.2016.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 12/15/2015] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
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46
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Krauter J, Heil G, Ganser A. The AML1/MTG8 Fusion Transcript in t(8;21) Positive AML and its Implication for the Detection of Minimal Residual Disease. Hematology 2016; 5:369-81. [DOI: 10.1080/10245332.2000.11746532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Jürgen Krauter
- Department of Hematology/Oncology, Hannover Medical School
| | - Gerhard Heil
- Department of Hematology/Oncology, Hannover Medical School
| | - Arnold Ganser
- Department of Hematology/Oncology, Hannover Medical School
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47
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Walsh JC, Arnold MG, Mohtashamian A. Myeloid Sarcoma: Presenting with Massive Cervical and Inguinal Lymphadenopathy. Head Neck Pathol 2016; 11:219-223. [PMID: 27395055 PMCID: PMC5429266 DOI: 10.1007/s12105-016-0742-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/28/2016] [Indexed: 11/30/2022]
Abstract
A 21 year old Active Duty Marine presented with acute onset of diffuse lymphadenopathy and B-symptoms. Biopsy was conducted which demonstrated myeloid sarcoma. Myeloid sarcoma is diagnostic for AML but is only present in 2-8 % of patients with AML. Our article presents a classic presentation and histologic appearance and discusses the current status of the literature.
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Affiliation(s)
- John C. Walsh
- Laboratory Department, Naval Medical Center San Diego, San Diego, CA USA
| | - Michelle G. Arnold
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, CA USA
| | - Arash Mohtashamian
- Laboratory Department, Naval Medical Center San Diego, San Diego, CA USA
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48
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Abu-Zeinah GF, Weisman P, Ganesh K, Katz SS, Dogan A, Abou-Alfa GK, Stein EM, Jarnagin W, Mauro MJ, Harding JJ. Acute myeloid leukemia masquerading as hepatocellular carcinoma. J Gastrointest Oncol 2016; 7:E31-5. [PMID: 27284485 DOI: 10.21037/jgo.2015.12.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is often diagnosed on the basis of high quality imaging without a biopsy in the cirrhotic liver. This is a case of a 64-year-old Caucasian man with no history of liver disease or cirrhosis that presented with fatigue, weight loss, and abdominal distension and was found to have a large, isolated liver mass with arterial enhancement and portal venous washout on triple-phase computed tomography (CT) suspicious for HCC. The patient was initially referred for a surgical evaluation. Meanwhile, he developed fevers, pancytopenia, and worsening back pain, and a subsequent spinal MRI revealed a heterogeneous bone marrow signal suspicious for metastatic disease. A bone marrow biopsy that followed was diffusely necrotic. A core biopsy of the patient's liver mass was then performed and was diagnostic of acute monocytic-monoblastic leukemia. Findings from peripheral flow cytometry and a repeat bone marrow biopsy were also consistent with this diagnosis, and induction chemotherapy with cytarabine and idarubicin was initiated. This case describes a rare presentation of myeloid sarcoma (MS) as an isolated, hypervascular liver mass that mimics HCC in its radiographic appearance. Due to the broad differential for a liver mass, a confirmatory biopsy should routinely be considered prior to surgical intervention.
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Affiliation(s)
- Ghaith F Abu-Zeinah
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Paul Weisman
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Karuna Ganesh
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Seth S Katz
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Ahmet Dogan
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Ghassan K Abou-Alfa
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Eytan M Stein
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - William Jarnagin
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Michael J Mauro
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - James J Harding
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Department of Medicine, Weill Cornell Medical College, New York, NY, USA ; 3 Departments of Pathology and Laboratory Medicine, 4 Department of Radiology, 5 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 6 Department of Surgery, Weill Cornell Medical College, New York, NY, USA
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Solh M, Solomon S, Morris L, Holland K, Bashey A. Extramedullary acute myelogenous leukemia. Blood Rev 2016; 30:333-9. [PMID: 27094614 DOI: 10.1016/j.blre.2016.04.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/28/2016] [Accepted: 04/01/2016] [Indexed: 12/26/2022]
Abstract
Extramedullary leukemia (EM AML), also known as myeloid sarcoma, is a rare manifestation of acute myelogenous leukemia and often accompanies bone marrow involvement. EM AML is diagnosed based on H&E stains with ancillary studies including flow cytometry and cytogenetics. Isolated EM AML is often misdiagnosed as large cell lymphoma or other lymphoproliferative disorder. The clinical presentation is often dictated by the mass effect and the location of the tumor. The optimal treatment remains unclear. High-dose chemotherapy, radiation, surgical resection, and allogeneic stem cell transplantation are all modalities that can be incorporated into the therapy of EM AML. Cytarabine-based remission induction regimens have been the most commonly used in the upfront setting. There are limited data about the optimal consolidation. Transplantation is ideally offered for high risk disease or in the relapsed setting. In this manuscript, we will review the recent literature about EM AML, focusing on therapy and proposing a treatment algorithm for managing this rare form of leukemia. Further studies addressing risk stratification, role of molecular and genetic aberrations, and optimal treatment strategies are warranted.
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Affiliation(s)
- Melhem Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA.
| | - Scott Solomon
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Lawrence Morris
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Kent Holland
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Asad Bashey
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
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50
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Higher EZH2 expression is associated with extramedullary infiltration in acute myeloid leukemia. Tumour Biol 2016; 37:11409-20. [PMID: 27000755 DOI: 10.1007/s13277-016-4983-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/07/2016] [Indexed: 12/12/2022] Open
Abstract
Accumulating evidence indicates that enhancer of zeste homolog 2 (EZH2) promotes the metastatic ability of solid tumors, but the role of EZH2 in extramedullary infiltration (EMI) in acute myeloid leukemia (AML) has not been thoroughly explored. In the present study, we investigated the possible association between EZH2 and EMI. We found that the messenger RNA (mRNA) and protein expression levels of EZH2 in AML patients were both significantly higher than in idiopathic thrombocytopenic purpura (ITP) patients. Furthermore, a positive correlation between EZH2 mRNA expression and percentage of peripheral blood blasts wa s found in AML patients (r = 0.404, p = 0.009). The migratory capacities of Kasumi-1 and HL-60, which both show a high level of EZH2 expression, were markedly higher than those of U937 and KG-1α. In contrast, silencing of EZH2 resulted in reduction in proliferation and migration ability and an increase in apoptosis. The latter observation was accompanied by reduced expression of associated proteins p-ERK, p-cmyc, and matrix metalloproteinase 2 (MMP-2) and an increase in epithelial cadherin (E-cadherin). These data suggest that higher expression of EZH2 may be associated with extramedullary infiltration in acute myeloid leukemia and affect pathogenesis via activation of the p-ERK/p-cmyc/MMP-2 and E-cadherin signaling pathways.
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