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Acute myeloid leukemia presenting with extensive bone marrow necrosis, leukemia cutis and testicular involvement: successful treatment with allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 51, pages 454–455 (2016)Cite this article

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We read with interest the article by Pan et al. recently published in Bone Marrow Transplantation.1 The authors reported a case of extensive bone marrow necrosis (BMN) in a child with chronic myelogenous leukemia, which resolved completely 4 weeks after allogeneic umbilical cord blood mesenchymal stem cell transplantation. In contrast to traditional treatments focusing on the primary disease and supportive care,2 the report by Pan et al. represents the first therapeutic attempt to target BMN itself. Here, we report on successful treatment, using allogeneic hematopoietic stem cell transplantation (allo-HSCT), of a rare case of mixed lineage leukemia (MLL)-rearranged AML presenting with extensive BMN, leukemia cutis and testicular involvement.

The patient received induction chemotherapy using the CLAM (cladribine, cytarabine and mitoxantrone) regimen, followed by radiation (total dose: 2400 cGy) to the scrotum and left testicle, and one cycle of consolidation with high-dose cytarabine (3000 mg/m2 every 12 h for six doses). A complete resolution of skin lesions and testicular swelling was noted. However, extensive BMN persisted throughout treatment. He then underwent a matched unrelated donor allo-HSCT with G-CSF mobilized PBSCs and myeloablative conditioning using fludarabine and fractionated TBI (1200 cGy). For GvHD prophylaxis, he received high-dose cyclophosphamide at a dose of 50 mg/kg on days +3 and +4 along with tacrolimus (continued until day +180) and mycophenolate mofetil (stopped on day +35). His post-transplant course was unremarkable with no evidence of acute or chronic GvHD. On day +180 post-transplant follow-up visit, his counts and physical examination were normal and donor chimerism was 100%. Interestingly, although normal hematopoietic islands were observed in some areas of the marrow (Figure 1c), significant necrosis continued to be present in neighboring areas (Figure 1d).

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References

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  1. BMT and Leukemia Program, Washington University School of Medicine, St Louis, MO, USA

    A Rashidi, J F DiPersio, P Westervelt, C N Abboud & R Romee

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  1. A Rashidi
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  2. J F DiPersio
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  3. P Westervelt
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  4. C N Abboud
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  5. R Romee
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Correspondence to R Romee.

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Rashidi, A., DiPersio, J., Westervelt, P. et al. Acute myeloid leukemia presenting with extensive bone marrow necrosis, leukemia cutis and testicular involvement: successful treatment with allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 51, 454–455 (2016). https://doi.org/10.1038/bmt.2015.272

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