Abstract
Isolated extramedullary relapse (iEMR) of acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare and has a dismal prognosis. Among 67 patients with AML after allo-HSCT, iEMR and bone marrow relapse occurred in 6% and 20.9%, respectively, with a median time to relapse of 11.5 and 6.5 months, respectively. Here, we presented 4 iEMR-AML cases. Common relapse locations occurred in the central nervous system, skin, and lymph nodes. We also report a rare case of cardiac iEMR that responded to chemoradiotherapy. Two cases responded to local/systemic treatments, which resulted in prolonged survival. Another case had iEMR in the presence of chronic graft-versus-host disease. Bone marrow relapse occurring after iEMR was typical and found in three-fourths of the cases. In conclusion, iEMR-AML occurrence after allo-HSCT is not rare in Thai patients. Its unpredictability and lack of graft-versus-leukemia effect highlight the importance of monitoring EMR carefully and promptly providing treatments once it is detected.
References
Mar 26, 1999·Cancer·Y KocE Berkman
Dec 2, 2000·Bone Marrow Transplantation·G ChongA Grigg
Oct 2, 2003·Bone Marrow Transplantation·K-H LeeJ-S Lee
Jul 16, 2005·Leukemia & Lymphoma·Ismail Oguz KaraBanu Kara
Oct 27, 2006·Leukemia & Lymphoma·Isabel Cunningham
Jul 31, 2010·Cancer·Marcos de LimaGuillermo Garcia-Manero
Jun 28, 2011·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Melhem SolhDan S Kaufman
Sep 24, 2011·Journal of Pediatric Hematology/oncology·Thomas CashAmir Mian
May 29, 2012·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Satoshi YoshiharaHiroyasu Ogawa
Oct 16, 2012·Haematologica·Andrew C HarrisJohn E Levine
Feb 20, 2013·Asia-Pacific Journal of Clinical Oncology·Cameron CurleyGlen A Kennedy
Apr 8, 2014·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Ling GeXiaowen Tang
Nov 3, 2016·Bone Marrow Transplantation·P TsirigotisA Nagler
Nov 30, 2016·Blood·Hartmut DöhnerClara D Bloomfield
Apr 12, 2017·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Noga Shem-TovAvichai Shimoni
Jan 27, 2018·Bone Marrow Transplantation·Noura AlhashimRiad El Fakih
May 28, 2019·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Ioanna SakellariAchilles Anagnostopoulos