Limits...
A case of donor-derived granulocytic sarcoma after allogeneic hematopoietic stem cell transplantation.

Jeong SH, Han JH, Jeong SY, Kang SY, Lee HW, Choi JH, Park JS - Korean J Hematol (2010)

Bottom Line: A Y chromosome PCR was performed on the patient's duodenum specimen as well as bone marrow aspirate in order to check the patient-origin cells.The duodenal specimen was found to contain 41.2% SRY-positive cells (from the donor).The patient died of sepsis during the nadir state 35 days after starting salvage chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT
The occurrence of granulocytic sarcoma as a pattern of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. In this paper, we report a rare case of acute myeloid leukemia (AML) relapsed as a granulocytic sarcoma of the donor type. The patient was diagnosed as having AML and underwent an allo-HSCT from his matched sibling donor. Fifty-seven months after allo-HSCT, he developed granulocytic sarcomas of duodenum, jejunum, and left sterno-cleido-mastoid muscle. The bone marrow was normal with 100% donor chimerism. A Y chromosome PCR was performed on the patient's duodenum specimen as well as bone marrow aspirate in order to check the patient-origin cells. The duodenal specimen was found to contain 41.2% SRY-positive cells (from the donor). Repeat endoscopy on day 2 of chemotherapy showed that the granulocytic sarcoma had shrunk dramatically. The patient died of sepsis during the nadir state 35 days after starting salvage chemotherapy.

No MeSH data available.


Related in: MedlinePlus

Infiltrating cells were immunoreactive for CD34. Immunohistochemical stain. ×400.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2982999&req=5

Figure 2: Infiltrating cells were immunoreactive for CD34. Immunohistochemical stain. ×400.

Mentions: A 35-year-old man presented with fever, weight loss, and a sore throat, which had persisted for 2 months. He was diagnosed as having AML with positive expression of CD3, CD5, CD7, CD13, CD22, CD33, CD34, and cytoplasmic myeloperoxidase. Cytogenetic analysis of the leukemic cells showed a normal 46, XY karyotype. He was initially treated with idarubicin (12 mg/m2/d for 3 days) and cytarabine (200 mg/m2/d for 7 days). Follow-up bone marrow biopsy performed 28 d after the completion of chemotherapy showed complete remission of the acute leukemia. After 1 cycle of consolidation chemotherapy using the same regimen as used previously, the patient underwent an allo-HSCT from his HLA full-matched sibling (sister) donor. The conditioning regimen for the allo-HSCT was a combination of busulfan (4 mg/kg for 4 days) and cyclophosphamide (60 mg/kg for 2 days). Cyclosporine and methotrexate were administered for graft versus host disease (GVHD) prophylaxis after the allo-HSCT. Morphological complete remission and complete donor chimerism were confirmed by a bone marrow biopsy and chimerism study, respectively, performed at D+28 after the HSCT. Ten months after the HSCT, grade III GVHD developed in the patient's liver; however, this was successfully treated with steroids and cyclosporin. Fifty-seven months after the HSCT, the patient developed gastrointestinal (GI) symptoms of nausea, vomiting, and epigastric pain. Endoscopic examination revealed a mass lesion growing into the lumen of the second portion of the duodenum (Fig. 1), and subsequent biopsy confirmed the duodenal lesion as a GS (Fig. 2). Multiple jejunal mass involvement was observed on a computed tomography (CT) scan. The bone marrow was, nevertheless, free of acute leukemic blast cells and a chimerism study again showed complete donor chimerism. The chimerism study performed on a duodenal biopsy specimen by multiplex short tandem repeat amplification revealed that 41.2% of the cells were of donor origin (Fig. 3). During the period of evaluation of the duodenal lesion and bone marrow, the patient developed a mass lesion in his left SCM muscle. The specimen obtained from the neck mass by needle aspiration biopsy also showed aggregations of acute leukemic cells. The patient was administered second-line induction chemotherapy comprising mitoxantrone (10 mg/m2/d for 3 days), etoposide (100 mg/m2/d for 4 days), and cytarabine (2,000 mg/m2/d for 5 days). Repeated endoscopy on day 2 of the chemotherapy showed that the GS had shrunk dramatically. However, pneumonia and sepsis developed during a neutropenic period after chemotherapy and the patient died of septic shock.


A case of donor-derived granulocytic sarcoma after allogeneic hematopoietic stem cell transplantation.

Jeong SH, Han JH, Jeong SY, Kang SY, Lee HW, Choi JH, Park JS - Korean J Hematol (2010)

Infiltrating cells were immunoreactive for CD34. Immunohistochemical stain. ×400.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2982999&req=5

Figure 2: Infiltrating cells were immunoreactive for CD34. Immunohistochemical stain. ×400.
Mentions: A 35-year-old man presented with fever, weight loss, and a sore throat, which had persisted for 2 months. He was diagnosed as having AML with positive expression of CD3, CD5, CD7, CD13, CD22, CD33, CD34, and cytoplasmic myeloperoxidase. Cytogenetic analysis of the leukemic cells showed a normal 46, XY karyotype. He was initially treated with idarubicin (12 mg/m2/d for 3 days) and cytarabine (200 mg/m2/d for 7 days). Follow-up bone marrow biopsy performed 28 d after the completion of chemotherapy showed complete remission of the acute leukemia. After 1 cycle of consolidation chemotherapy using the same regimen as used previously, the patient underwent an allo-HSCT from his HLA full-matched sibling (sister) donor. The conditioning regimen for the allo-HSCT was a combination of busulfan (4 mg/kg for 4 days) and cyclophosphamide (60 mg/kg for 2 days). Cyclosporine and methotrexate were administered for graft versus host disease (GVHD) prophylaxis after the allo-HSCT. Morphological complete remission and complete donor chimerism were confirmed by a bone marrow biopsy and chimerism study, respectively, performed at D+28 after the HSCT. Ten months after the HSCT, grade III GVHD developed in the patient's liver; however, this was successfully treated with steroids and cyclosporin. Fifty-seven months after the HSCT, the patient developed gastrointestinal (GI) symptoms of nausea, vomiting, and epigastric pain. Endoscopic examination revealed a mass lesion growing into the lumen of the second portion of the duodenum (Fig. 1), and subsequent biopsy confirmed the duodenal lesion as a GS (Fig. 2). Multiple jejunal mass involvement was observed on a computed tomography (CT) scan. The bone marrow was, nevertheless, free of acute leukemic blast cells and a chimerism study again showed complete donor chimerism. The chimerism study performed on a duodenal biopsy specimen by multiplex short tandem repeat amplification revealed that 41.2% of the cells were of donor origin (Fig. 3). During the period of evaluation of the duodenal lesion and bone marrow, the patient developed a mass lesion in his left SCM muscle. The specimen obtained from the neck mass by needle aspiration biopsy also showed aggregations of acute leukemic cells. The patient was administered second-line induction chemotherapy comprising mitoxantrone (10 mg/m2/d for 3 days), etoposide (100 mg/m2/d for 4 days), and cytarabine (2,000 mg/m2/d for 5 days). Repeated endoscopy on day 2 of the chemotherapy showed that the GS had shrunk dramatically. However, pneumonia and sepsis developed during a neutropenic period after chemotherapy and the patient died of septic shock.

Bottom Line: A Y chromosome PCR was performed on the patient's duodenum specimen as well as bone marrow aspirate in order to check the patient-origin cells.The duodenal specimen was found to contain 41.2% SRY-positive cells (from the donor).The patient died of sepsis during the nadir state 35 days after starting salvage chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT
The occurrence of granulocytic sarcoma as a pattern of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. In this paper, we report a rare case of acute myeloid leukemia (AML) relapsed as a granulocytic sarcoma of the donor type. The patient was diagnosed as having AML and underwent an allo-HSCT from his matched sibling donor. Fifty-seven months after allo-HSCT, he developed granulocytic sarcomas of duodenum, jejunum, and left sterno-cleido-mastoid muscle. The bone marrow was normal with 100% donor chimerism. A Y chromosome PCR was performed on the patient's duodenum specimen as well as bone marrow aspirate in order to check the patient-origin cells. The duodenal specimen was found to contain 41.2% SRY-positive cells (from the donor). Repeat endoscopy on day 2 of chemotherapy showed that the granulocytic sarcoma had shrunk dramatically. The patient died of sepsis during the nadir state 35 days after starting salvage chemotherapy.

No MeSH data available.


Related in: MedlinePlus