Three AML patients with existing or pre-existing intracerebral granulocytic sarcomas who were successfully treated with allogeneic bone marrow transplantations

Abstract

Summary:We report three acute myelogenous leukemia (AML) patients who developed intracerebral granulocytic sarcomas (GS) and were successfully treated with allogeneic BMT (allo-BMT). The diagnosis of one patient was AML M2 with myelofibrosis, and the other two patients were AML M4 with eosinophilia (AML M4 Eo), according to the FAB classification. Two patients first experienced a relapse in the brain that resulted in the formation of GS, followed by a relapse in the bone marrow. The remaining patient developed an optic nerve GS after suffering a bone marrow relapse. All three patients received irradiation for the GS and systemic chemotherapy before the allo-BMT. TBI was used for conditioning, and GVHD prophylaxis was with cyclosporine (CsA) and short-term MTX in all three cases. These patients are currently 9 to 37 months post-BMT without relapse. Thus, our experience suggests that allo-BMT is an effective treatment for AML patients with existing or pre-existing intracerebral GS. Keywords: AML; intracerebral granulocytic sarcoma; allogeneic BMT Granulocytic sarcoma (GS) is a rare extramedullary tumor composed of myeloblasts and other granulocytic precursors. The subgroups of AML, AML M2 with t(8;21)(q22;q22) 1 and AML with CD56-positive leukemic cells 2 tend to develop GS. Granulocytic sarcoma can occur at any location in the body in patients with adult AML, but it rarely does in the CNS. 3 Although such patients receive intracerebral treatment, whole brain irradiation, and/or systemic chemotherapy, they have low complete remission (CR) rates and short overall survivals. Hence, in some cases, aggressive therapy such as bone marrow transplantation is recommended. This report documents three AML patients with existing or pre-existing intracerebral GS who were successfully treated with allo-BMT. Case reports Case 1A 46-year-old male was diagnosed with AML M2, with myelofibrosis. At diagnosis, cytogenetic analysis showed 46, XY, 9q−. Flow cytometric analysis was compatible with AML, but CD56 was not examined. He achieved CR with enocitabine (BHAC) 2200 mg/m 2 i.v., daunorubicin (DNR) 240 mg/m 2 i.v. and mercaptopurine (6-MP) 700 mg/m 2 p.o. (total dose). Eleven months later, however, he complained of nausea, vomiting, and headache. A brain CT revealed the presence of enhanced multiple mass lesions. There was no indication of a bone marrow relapse, and a brain biopsy was not performed. A CNS relapse was diagnosed resulting in the formation of GS, and whole brain irradiation was given to 40 Gy. A brain CT subsequently detected no mass lesion. Notwithstanding, this patient suffered a bone marrow relapse 6 months later. He then received induction therapy with mitoxantrone (MIT) 30 mg/m 2 i.v., cytosine arabinoside (ara-C) 700 mg/m 2 i.v. and etoposide (VP-16) 560 mg/m 2 i.v., and the myeloblasts decreased to 7% of the bone marrow nucleated cells. Following this chemotherapy, he complained of a gait disturbance, and a brain MRI revealed mass lesions in the right frontal and left occipital lobes. Whole brain irradiation (...

Acute myeloid leukemia with concurrent myeloid sarcoma treated with autologous bone marrow transplantation: two illustrative cases and a literature review

“…Stem cell transplantation may improve survival by virtue of the high dose chemotherapy and total body irradiation regimens employed. Several authors have reported allogeneic stem cell transplantation to be part of successful treatment [19,20]. This may be attributable not only to the high dose conditioning therapy but also to the graft-versus-leukemia (GVL) effect associated with allogeneic stem cell transplantation.…”

Nonmyeloablative allogeneic bone marrow transplantation for orbital granulocytic sarcoma associated with t(8;21)(q22;q22) in acute myeloid leukemia

“…4,7,8 Tallman et al 4 reported one case with persistent orbital GS and multiple GS in the right lung who was successfully treated with allo-BMT. Kowal-Vern et al 8 presented a case with GS of the ileum that was also successfully treated with surgical excision of the primary tumor and allo-BMT.…”