Comparison in treatments of nonleukemic granulocytic sarcoma

Abstract

BACKGROUNDThe purpose of this study was to reveal the clinical characteristics of nonleukemic granulocytic sarcoma (GS) and an association between the therapeutic regimens and the nonleukemic period.METHODClinical records of 2 patients reported here and 72 patients gathered using a literature search on Medline from other institutions were analyzed. The patients consisted of 57 patients who preceded acute nonlymphoblastic leukemia (ANLL) and 17 patients who did not develop ANLL. These patients were divided into 3 groups by therapeutic regimens; Group I included 12 patients who received only biopsy or surgical resection of the tumor, Group II was 20 patients who received local irradiation for the tumor, and Group III consisted of 42 patients who received systemic chemotherapy. The nonleukemic periods between these groups were compared. In Group III, the period in the patients who were treated with chemotherapy given to ANLL was compared with that in the patients who received chemotherapy used for malignant lymphoproliferative disorders (MLPDs).RESULTSThirty‐five patients (47%) initially were misdiagnosed, and the disease was most often malignant lymphoma. Preferential sites of GS were the small intestine, mediastinum, epidural site, uterus, and ovary, which often are difficult for the detection and diagnosis in addition to the skin and lymph nodes known commonly. The nonleukemic period after the diagnosis of GS was significantly longer in Group III than in the other groups (median, 12 months in Group III vs. 3 and 6 months in Groups I and II, respectively). The aggressive chemotherapy given to ANLL led to a longer nonleukemic period than the chemotherapy used for MLPDs.CONCLUSIONSTo reduce the risk of subsequent ANLL in patients with nonleukemic GS, it is important that accurate histologic diagnosis is established initially for GS and that all isolated cases of GS, even those that appear to be cured by resection or irradiation of the tumor, are treated with intensive chemotherapy similar to that used to treat ANLL during the nonleukemic period as soon as possible. Cancer 2002;94:1739–46. © 2002 American Cancer Society.DOI 10.1002/cncr.10399

Prognostic Factors of Treatment Outcomes in Patients with Granulocytic Sarcoma

“…Since GS is an extramedullary tumor associated with AML, GS should be included in the differential diagnosis when AML patients present with abnormal physical symptoms and signs [1,13,28]. However, the diagnosis of GS in patients without a history of leukemia is still challenging due to limited clinical experience; up to 50–75% of these cases may initially be misdiagnosed, usually as lymphoma, Ewing sarcoma or acute lymphoblastic leukemia [15,16]. The helpful clues for identification include the detection of eosinophilic myelocytes which are present only in well-differentiated GS, Leder stain and immunohistochemical staining for lysozyme and MPO that is highly sensitive and specific with positive results in more than 90% of cases [29].…”

“…Treatment options include surgical decompression, chemotherapy, radiotherapy or any combination of these treatments. The general consensus is to treat these patients with conventional AML-type chemotherapeutic protocols in all cases even when tumors appear to be cured by resection or irradiation [15,16,20]. It has been known that the isolated GS left untreated before leukemia will almost always progress to AML, and a longer disease-free interval in patients treated with AML regimen will also improve survival [15].…”

“…The current recommended treatment regimen is conventional AML-type chemotherapeutic protocols in all patients even with tumors which appear to be cured by resection or irradiation [15,16,19,20,21]. On the other hand, other treatment modalities including surgical decompression, radiotherapy or other combination may also be clinically necessary on an individual basis.…”

Sarcome myéloïde du sinus maxillaire : un diagnostic difficile

“…C'est pourquoi le sarcome myéloïde formé exclusivement d'un tapis de cellules indifférenciées met le pathologiste devant un diagnostic différentiel difficile : un taux de plus de 50 % de diagnostics erronés est rapporté dans la littérature en cas de sarcome myéloïde peu différencié survenant en l'absence de pathologie hématologique [3][4][5]. Le plus souvent, la lésion est confondue avec un lymphome à grandes cellules ou avec un autre sarcome.…”

Complete Response of Myeloid Sarcoma with <b><i>FIP1L1-PDGFRA</i></b>-Associated Myeloproliferative Neoplasms to Imatinib Mesylate Monotherapy

“…MS behaves as aggressively as de novo AML and always progresses to bone marrow involvement, leading to grave outcomes [1]. Therefore, MS must be aggressively treated with systemic chemotherapy, even if it has been treated effectively with surgery or radiotherapy [2,3]. …”