Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Acute Leukemias

Allogeneic hematopoietic stem cell transplantation for adult AML patients with granulocytic sarcoma

Abstract

We recently reported that adult acute myeloid leukemia (AML) patients with granulocytic sarcoma (GS) possessed unique clinical features and poor prognosis. However, the optimal therapeutic strategy for this entity has not been established. Therefore, the aim of this study was to assess the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the management of AML with GS. We retrospectively analyzed 503 consecutive adult AML patients (median age, 44 years; range, 15–73 years) who received allo-HSCT. A total of 44 patients (8.7%) had GS before transplantation. Patients with GS achieved comparable survival to those without GS (5-year overall survival (OS), 47% vs 44%, respectively, P=0.621). In patients with GS, excellent outcomes were seen in those that underwent allo-HSCT while in complete remission, whereas nine out of ten patients with GS at the time of transplant experienced a relapse within 6 months after allo-HSCT. Local irradiation for GS prior to allo-HSCT and acute and chronic graft-versus-host disease did not affect survival significantly. Multivariate analysis identified age, disease status and the use of myeloablative conditioning as independent prognostic factors for OS. These data suggest that better control of GS prior to allo-HSCT is crucial to improve the outcome of transplantation for those with GS.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Muss HB, Moloney WC . Chloroma and other myeloblastic tumors. Blood 1973; 42: 721–728.

    CAS  PubMed  Google Scholar 

  2. Byrd JC, Edenfield WJ, Shields DJ, Dawson NA . Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. J Clin Oncol 1995; 13: 1800–1816.

    Article  CAS  PubMed  Google Scholar 

  3. 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: 340–350.

    Article  CAS  PubMed  Google Scholar 

  4. 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; e-pub ahead of print 9 May 2012; doi:10.1111/j.1349-7006.2012.02324.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 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: 466–475.

    Article  CAS  PubMed  Google Scholar 

  6. 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: 690–697.

    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: 4940–4943.

    Article  PubMed  Google Scholar 

  8. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR et al. Proposals for the classification of the acute leukaemias. French-American-British (FAB) co-operative group. Br J Haematol 1976; 33: 451–458.

    Article  CAS  PubMed  Google Scholar 

  9. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. IARC: Lyon, France, 2008.

    Google Scholar 

  10. Grimwade D, Walker H, Oliver F, Wheatley K, Harrison C, Harrison G et al. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1612 patients entered into the MRC AML 10 trial. The Medical Research Council Adult and Children’s Leukaemia Working Parties. Blood 1998; 92: 2322–2333.

    CAS  PubMed  Google Scholar 

  11. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  12. Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.

    Article  CAS  PubMed  Google Scholar 

  13. Simpson DR, Nevill TJ, Shepherd JD, Fung HC, Horsman DE, Nantel SH et al. High incidence of extramedullary relapse of AML after busulfan/cyclophosphamide conditioning and allogeneic stem cell transplantation. Bone Marrow Transplant 1998; 22: 259–264.

    Article  CAS  PubMed  Google Scholar 

  14. Lee KH, Lee JH, Kim S, Lee JS, Kim SH, Kim WK . High frequency of extramedullary relapse of acute leukemia after allogeneic bone marrow transplantation. Bone Marrow Transplant 2000; 26: 147–152.

    Article  CAS  PubMed  Google Scholar 

  15. Lee KH, Lee JH, Choi SJ, Lee JH, Kim S, Seol M et al. Bone marrow vs extramedullary relapse of acute leukemia after allogeneic hematopoietic cell transplantation: risk factors and clinical course. Bone Marrow Transplant 2003; 32: 835–842.

    Article  CAS  PubMed  Google Scholar 

  16. 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: 1100–1103.

    Article  PubMed  Google Scholar 

  17. Stevenson WS, Vincent PC, Iland HJ . Disseminated granulocytic sarcoma treated with allogeneic peripheral blood stem-cell transplantation. Leuk Lymphoma 2002; 43: 2221–2224.

    Article  CAS  PubMed  Google Scholar 

  18. Kozelj M, Zorman D, Mrevlje B, Cernelc P, Zver S . Cardiac granulocytic sarcoma diagnosed by intracardiac echocardiography-guided biopsy. Int J Hematol 2008; 88: 101–103.

    Article  PubMed  Google Scholar 

  19. Sugimoto Y, Nishii K, Sakakura M, Araki H, Usui E, Lorenzo VF et al. Acute myeloid leukemia with t(8;21)(q22;q22) manifesting as granulocytic sarcomas in the rhinopharynx and external acoustic meatus at relapse after high-dose cytarabine: case report and review of the literature. Hematol J 2004; 5: 84–89.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We wish to thank all of the staff in the participating institutions of the Kanto Study Group for Cell Therapy.

HS and TS designed and performed research, analyzed data and wrote the manuscript. MT, TM, TS, NK, YK, CN, SY, HF, SF, SM, and HK provided the patient data; SO provided the patient data and contributed to the final version of the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to H Shimizu.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shimizu, H., Saitoh, T., Tanaka, M. et al. Allogeneic hematopoietic stem cell transplantation for adult AML patients with granulocytic sarcoma. Leukemia 26, 2469–2473 (2012). https://doi.org/10.1038/leu.2012.156

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2012.156

Keywords

This article is cited by

Search

Quick links