Donor Cell Myeloid Sarcoma

Extramedullary tumors remain an obstacle to curing more acute leukemia patients. Their incidence is unknown because the presence of occult tumors that contribute to relapse is not routinely sought as in other cancers. No standard approach exists for treating tumors at most sites, apparent clinical response is typically followed by further tumors, and achievement of lengthy remission is uncommon. Body scanning with 18 FDG PET/CT now provides a means to identify the extent of occult tumors that enables directed tumor eradication and a way to evaluate tumor response. To evaluate its potential benefits, analysis was undertaken of 124 published cases scanned after apparent tumors were diagnosed. Clinical and radiologic exams underestimated extent of disease in over half of 100 cases. Among 70 cases that reported scans after various treatments, 70% achieved negative scans. Half relapsed subsequently but disease-free survivals up to 6 years were documented. These reported cases add to our knowledge of extramedullary leukemia in showing that further tumors are more likely than marrow relapse, clinical and radiologic evaluation of response is inadequate, intensive chemotherapy alone generally does not prevent progression and is associated with significant mortality, and tumor-directed plus systemic therapies appears the most effective approach, particularly to AML tumors. This analysis suggests this technology could increase our ability to eradicate all foci of leukemia, and identify tumors responsible for refractory, residual, and relapsed disease.

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“…Among 57 AML cases, scans documented treatment resistance in 13 and only partial tumor response in 6 . Negative scans were achieved in 38.…”

Section: Resultsmentioning

confidence: 99%

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Cunningham

Kohno

2016

American J Hematol

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“…Only one survived 10 months. Eighteen other patients had been treated for MDS or RAEB (blasts ranging from 7% to 32%) including 2 with transplants . In at least 11, marrows were considered to have transformed to AML.…”

Section: Resultsmentioning

confidence: 99%

Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed

Cunningham

Worthley

2018

American J Hematol

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Leukemia growing as tumors in gastrointestinal organs is an under-investigated cause of treatment failure and death. These present with symptoms often mistaken for common toxicities but may grow large before symptoms. To synthesize experience available only in case reports, 378 were analyzed. Invasive and metastatic behavior typical of solid GI tumors was revealed even when marrow was uninvolved. Within 3 months of diagnosis, 33% had died, 47% within 1 year. Survivals of 4 to 18 years after involvement suggest cure is possible. Evidence is presented that combined local and systemic therapy has successfully treated GI leukemic tumors when identified early.

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“…Multiple myeloma only makes up 1% of these posttransplant malignant lesions [ 6 ]. The most commonly described phenotype of DCL is AML although cases of myeloid sarcoma [ 3 ], gingival squamous cell carcinoma [ 10 ], B-cell immunoblastic sarcoma [ 11 ], and cutaneous melanoma [ 12 ] have also been described. Posttransplantation MM has been reported following solid organ transplantation of heart, lung, and kidneys [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Posttransplantation immunosuppression may furthermore act as a risk factor for malignancy. However, patients may also rarely develop a secondary malignancy or myelodysplastic syndrome of donor origin termed donor cell leukemia (DCL) [ 3 ]. The first case of DCL was described by Fialkow et al in 1971 and it has since mostly been published in case reports with acute myeloid leukemia (AML) being the most commonly described phenotype [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

A 54-Year-Old Woman with Donor Cell Origin of Multiple Myeloma after Allogeneic Hematopoietic Stem Cell Transplantation for the Treatment of CML

Maestas

Jain

Stiff

2016

Case Reports in Hematology

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Chronic myeloid leukemia is a myeloproliferative disorder that may be treated with hematopoietic stem cell transplantation (HSCT). While posttransplantation relapse of disease resulting from a failure to eradicate the patient's original leukemia could occur, patients may also rarely develop a secondary malignancy or myelodysplastic syndrome (MDS) of donor origin termed donor cell leukemia (DCL). Cases of donor-derived acute myeloid leukemia (AML) or MDS after HSCT or solid tumor transplantation have been published. However, very few cases of donor-derived multiple myeloma (MM) exist. We describe a patient who developed a donor-derived MM following allogeneic HSCT from a sibling donor.

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Donor Cell Myeloid Sarcoma

Abstract: Donor cell derived malignancies are a rare and interesting complication of allogeneic bone marrow transplantation. We present a case of a 56-year-old male with donor cell myeloid sarcoma of the stomach and myocardium.

Cited by 6 publications

References 12 publications

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed

A 54-Year-Old Woman with Donor Cell Origin of Multiple Myeloma after Allogeneic Hematopoietic Stem Cell Transplantation for the Treatment of CML

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Donor Cell Myeloid Sarcoma

Abstract: Donor cell derived malignancies are a rare and interesting complication of allogeneic bone marrow transplantation. We present a case of a 56-year-old male with donor cell myeloid sarcoma of the stomach and myocardium.

Cited by 6 publications

References 12 publications

18FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

18FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed

A 54-Year-Old Woman with Donor Cell Origin of Multiple Myeloma after Allogeneic Hematopoietic Stem Cell Transplantation for the Treatment of CML

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Product

Resources

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¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases

¹⁸FDG‐PET/CT: 21st century approach to leukemic tumors in 124 cases