Soft Tissue Sarcoma in the Setting of Chronic Cutaneous Graft Versus Host Disease After Allogenic Bone Marrow Transplantation

Abstract

Second primary cancers are approximately 2.1-2.8 times more common in survivors of bone marrow transplant than in the age-matched general population. We describe a patient who developed high-grade sarcoma in two disparate sites that were clinically involved by chronic cutaneous graft versus host disease (GVHD). This occurred 3.5 years after bone marrow transplant for acute myelogenous leukemia (AML). This suggests that malignant sarcomas may develop in the setting of chronic GVHD, and close surveillance of GVHD-related nodules is warranted.

High-Grade Supraclavicular Soft Tissue Sarcoma as Secondary Malignancy After Successful Treatment of Acute Myeloid Leukemia: Case Report and Literature Review

“…5,8,10,[14][15][16][17][19][20][21][22][23] However, GVHD, immunosuppressive therapy, and AML pose additional risks. 12,19,20,[24][25][26] Solid tumors occurring as secondary cancers in patient populations treated with BMT for hematopoetic malignancy have an incidence of 0.4% to 0.6%, 4,5,7,[9][10][11]13 and this risk increases with prolonged survival. 16 Among those, sarcomas are the least prevalent.…”

“…5,9,17,19 Although this mainly involves carcinomas of the skin or mucosal tissues, 4,13,14 an increased risk of STS remains. 10,12 We report the present case of an unusual STS after curative therapy for acute myeloid leukemia (AML) because published data of secondary STSs are rare.…”

“…4,5,[8][9][10][11]14,16 Therefore, patients with hematopoetic system malignancies have an increased risk of secondary malignant tumors because their treatment regimen often involves all these treatment approaches to achieve a cure. 9,12,[15][16][17][18] Recent data suggest an association between graft-versus-host disease (GVHD) after BMT and the occurrence of secondary neoplasms. 4,11,12,16 The underlying reasons range from the mutative potential of chemotherapeutic agents, especially alkylants, 9-11 irradiation, 7,17,19 and an uncontrolled, excessive inflammation process in GVHD, [15][16][17]19 to curbed host defense mechanisms resulting from immunosuppressive therapy, leading to a reduced detection of mutated cells.…”

“…9,12,[15][16][17][18] Recent data suggest an association between graft-versus-host disease (GVHD) after BMT and the occurrence of secondary neoplasms. 4,11,12,16 The underlying reasons range from the mutative potential of chemotherapeutic agents, especially alkylants, 9-11 irradiation, 7,17,19 and an uncontrolled, excessive inflammation process in GVHD, [15][16][17]19 to curbed host defense mechanisms resulting from immunosuppressive therapy, leading to a reduced detection of mutated cells. 4,15,19 As intensified treatment protocols for hematopoetic malignancies have led to prolonged survival or even cure, the incidence of secondary malignancies has increased.…”

“…Fewer than 10% of all STSs occur in the head and neck area, 1,2 and most of these are fibrosarcomas in the anterior or posterior neck. 2,3 However, the risk of developing a STS is increased, just as for other cancers, as a secondary malignancy after local or total body irradiation, 4-8 chemotherapy, [9][10][11] immunosuppressive therapy, 4,5,[12][13][14][15] and bone marrow transplantation (BMT). 4,5,[8][9][10][11]14,16 Therefore, patients with hematopoetic system malignancies have an increased risk of secondary malignant tumors because their treatment regimen often involves all these treatment approaches to achieve a cure.…”