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Characteristics and transplant outcome of myeloid sarcoma: a single-institute study

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Abstract

We performed a retrospective study describing the characteristics of myeloid sarcoma (MS) and evaluated the outcome of hematopoietic stem cell transplantation (HSCT) in patients with MS. There were 27 patients with de novo isolated MS, 34 with de novo leukemic MS and 13 with secondary leukemic MS in our study. Sixty-three patients received induction chemotherapy. Following induction therapy, 35 patients underwent HSCT, including 10 autogenous HSCT (auto-HSCT) and 25 allogeneic HSCT (allo-HSCT) cases. Compared with intensive chemotherapy only as consolidation treatment, HSCT (auto-/allo-HSCT) significantly improved the overall survival (OS) of MS patients (p < 0.05), while allo-HSCT also improved progression-free survival (PFS, p = 0.032). According to multivariate analysis, poorer prognosis in terms of OS was observed in older patients (p = 0.024, HR = 1.030, 95% CI 1.004–1.057), while HSCT (auto/allo-HSCT) had a favorable impact on OS for patients with MS (auto-HSCT, p = 0.044, HR = 0.201, 95% CI 0.042–0.959; allo-HSCT, p = 0.038, HR = 0.341, 95% CI 0.124–0.943). Extramedullary disease without complete remission (CR) after induction therapy was the sole variable independent of high OS and PFS (p = 0.049, HR = 2.243, 95% CI: 1.005–5.005; p = 0.017, HR = 2.535, 95% CI 1.180–5.448, respectively). The data indicate that HSCT is an effective treatment for patients with MS who have achieved CR of extramedullary disease after induction therapy.

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References

  1. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127:2391–405.

    Article  CAS  PubMed  Google Scholar 

  2. Bakst RL, Tallman MS, Douer D, Yahalom J. How I treat extramedullary acute myeloid leukemia. Blood. 2011;118:3785–93.

    Article  CAS  PubMed  Google Scholar 

  3. Byrd JC, Weiss RB, Arthur DC, Lawrence D, Baer MR, Davey F, et al. Extramedullary leukemia adversely affects hematologic complete remission rate and overall survival in patients with t(8;21)(q22;q22): results from Cancer and Leukemia Group B 8461. J Clin Oncol. 1997;15:466–75.

    Article  CAS  PubMed  Google Scholar 

  4. Döhner H, Estey EH, Amadori S, Appelbaum FR, Büchner T, Burnett AK, et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115:453–74.

    Article  PubMed  Google Scholar 

  5. Huter O, Brezinka C, Nachbaur D, Schwaighofer H, Lang A, Niederwieser D. Successful treatment of primary extramedullary leukemia (EML) of the uterus with radical surgery, chemotherapy, autologous bone marrow transplantation (BMT) and prophylactic local irradiation. Bone Marrow Transplant. 1996;18:663–4.

    CAS  PubMed  Google Scholar 

  6. Pileri SA, Ascani S, Cox MC, Campidelli C, Bacci F, Piccioli M, et al. Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients. Leukemia. 2007;21:340–50.

    Article  CAS  PubMed  Google Scholar 

  7. Chevallier P, Mohty M, Lioure B, Michel G, Contentin N, Deconinck E, et al. Allogeneic hematopoietic stem-cell transplantation for myeloid sarcoma: a retrospective study from the SFGM-TC. J Clin Oncol. 2008;26:4940–3.

    Article  PubMed  Google Scholar 

  8. Chevallier P, Labopin M, Cornelissen J, Socié G, Rocha V, Mohty M, et al. Allogeneic hematopoietic stem cell transplantation for isolated and leukemic myeloid sarcoma in adults: a report from the Acute Leukemia Working Party of the European group for Blood and Marrow Transplantation. Haematologica. 2011;96:1391–4.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shimizu H, Saitoh T, Tanaka M, Mori T, Sakura T, Kawai N, et al. Allogeneic hematopoietic stem cell transplantation for adult AML patients with granulocytic sarcoma. Leukemia. 2012;26:2469–73.

    Article  CAS  PubMed  Google Scholar 

  10. Lazzarotto D, Candoni A, Filì C, Forghieri F, Pagano L, Busca A, et al. (2017) Clinical outcome of myeloid sarcoma in adult patients and effect of allogeneic stem cell transplantation. Results from a multicenter survey. Leuk Res 53: 74–81.

  11. Bourlon C, Lipton JH, Deotare U, Gupta V, Kim DD, Kuruvilla J, et al. Extramedullary disease at diagnosis of AML does not influence outcome of patients undergoing allogeneic hematopoietic cell transplant in CR1. Eur J Haematol. 2017;99:234–9.

    Article  CAS  PubMed  Google Scholar 

  12. Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129:424–47.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tsimberidou AM, Kantarjian HM, Estey E, Cortes JE, Verstovsek S, Faderl S, et al. Outcome in patients with nonleukemic granulocytic sarcoma treated with chemotherapy with or without radiotherapy. Leukemia. 2003;17:1100–3.

    Article  PubMed  Google Scholar 

  14. Gordon MY, Blackett NM. Reconstruction of the hematopoietic system after stem cell transplantation. Cell Transplant. 1998;7:339–44.

    Article  CAS  PubMed  Google Scholar 

  15. Schoemans HM, Lee SJ, Ferrara JL, Wolff D, Levine JE, Schultz KR, et al. EBMT-NIH-CIBMTR Task Force position statement on standardized terminology & guidance for graft-versus-host disease assessment. Bone Marrow Transplant. 2018;53:1401–15.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Simon R, Makuch RW. A non-parametric graphical representation of the relationship between survival and the occurrence of an event: application to responder versus non-responder bias. Stat Med. 1984;3:35–44.

    Article  CAS  PubMed  Google Scholar 

  17. Mantel N, Byar DP. Evaluation of response-time data involving transient States: an illustration using heart-transplant data. Public Am Stat Assoc. 1974;69:81–6.

    Article  Google Scholar 

  18. Tsimberidou AM, Kantarjian HM, Wen S, Keating MJ, O’Brien S, Brandt M, et al. Myeloid sarcoma is associated with superior event-free survival and overall survival compared with acute myeloid leukemia. Cancer. 2008;113:1370–8.

    Article  PubMed  Google Scholar 

  19. Yamauchi K, Yasuda M. Comparison in treatments of nonleukemic granulocytic sarcoma: report of two cases and a review of 72 cases in the literature. Cancer. 2002;94:1739–46.

    Article  PubMed  Google Scholar 

  20. Shimizu H, Saitoh T, Hatsumi N, Takada S, Yokohama A, Handa H, et al. Clinical significance of granulocytic sarcoma in adult patients with acute myeloid leukemia. Cancer Sci. 2012;103:1513–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Xu LH, Wang Y, Chen ZY, Fang JP. Myeloid sarcoma is associated with poor clinical outcome in pediatric patients with acute myeloid leukemia. J Cancer Res Clin Oncol. 2020;146:1011–20.

    Article  CAS  PubMed  Google Scholar 

  22. Vodyanik MA, Thomson JA, Slukvin II. Leukosialin (CD43) defines hematopoietic progenitors in human embryonic stem cell differentiation cultures. Blood. 2006;108:2095–105.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Broyde A, Boycov O, Strenov Y, Okon E, Shpilberg O, Bairey O. Role and prognostic significance of the Ki-67 index in non-Hodgkin’s lymphoma. Am J Hematol. 2009;84:338–43.

    Article  PubMed  Google Scholar 

  24. Tallman MS, Hakimian D, Shaw JM, Lissner GS, Russell EJ, Variakojis D. Granulocytic sarcoma is associated with the 8;21 translocation in acute myeloid leukemia. J Clin Oncol. 1993;11:690–7.

    Article  CAS  PubMed  Google Scholar 

  25. Psiachou-Leonard E, Paterakis G, Stefanaki K, Mikraki-Christou V, Haidas S. Cerebellar granulocytic sarcoma in an infant with CD56+ acute monoblastic leukemia. Leuk Res. 2001;25:1019–21.

    Article  CAS  PubMed  Google Scholar 

  26. Falini B, Lenze D, Hasserjian R, Coupland S, Jaehne D, Soupir C, et al. Cytoplasmic mutated nucleophosmin (NPM) defines the molecular status of a significant fraction of myeloid sarcomas. Leukemia. 2007;21:1566–70.

    Article  CAS  PubMed  Google Scholar 

  27. Ansari-Lari MA, Yang CF, Tinawi-Aljundi R, Cooper L, Long P, Allan RH, et al. FLT3 mutations in myeloid sarcoma. Br J Haematol. 2004;126:785–91.

    Article  CAS  PubMed  Google Scholar 

  28. Willekens C, Renneville A, Broutin S, Saada V, Micol JB, Delahousse J, et al. Mutational profiling of isolated myeloid sarcomas and utility of serum 2HG as biomarker of IDH1/2 mutations. Leukemia. 2018;32(9):2008–81.

    Article  CAS  PubMed  Google Scholar 

  29. Kashofer K, Gornicec M, Lind K, Caraffini V, Schauer S, Beham-Schmid C, et al. Detection of prognostically relevant mutations and translocations in myeloid sarcoma by next generation sequencing. Leuk Lymphoma. 2018;59:501–4.

    Article  CAS  PubMed  Google Scholar 

  30. Lazarevic V, Orsmark-Pietras C, Lilljebjörn H, Pettersson L, Rissler M, Lübking A, et al. Isolated myelosarcoma is characterized by recurrent NFE2 mutations and concurrent preleukemic clones in the bone marrow. Blood. 2018;131:577–81.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Dr. Depei Wu and Xiang Zhang contributed to the conception of the study and manuscript revision. Meng Shan, Yutong Lu and Menglu Yang contributed to collecting and performing the data analysis and preparing the manuscript. Peng Wang, Shenqi Lu and Luwei Zhang helped collect and perform data analysis and prepare the manuscript. Huiying Qiu, Suning Chen and Yang Xu contributed to the data analysis and manuscript revision. All the data were from Jiangsu Biobank of Clinical Resources.

Funding

This work was supported by grants from the National Natural Science Foundation of China (81730003, 81870120), the Natural Science Foundation of Jiangsu Province (BK20171205), the Social Development Project of Jiangsu Province (BE2019655), the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), and the National Key Research and Development Program (2017ZX09304021, 2017YFA0104500 and 2019YFC0840604).

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Authors and Affiliations

  1. Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, People’s Republic of China

    Meng Shan, Yutong Lu, Menglu Yang, Peng Wang, Shenqi Lu, Luwei Zhang, Huiying Qiu, Suning Chen, Yang Xu, Xiang Zhang & Depei Wu

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  1. Meng Shan
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Shan, M., Lu, Y., Yang, M. et al. Characteristics and transplant outcome of myeloid sarcoma: a single-institute study. Int J Hematol 113, 682–692 (2021). https://doi.org/10.1007/s12185-021-03081-2

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