دانلود رایگان مقاله انگلیسی سارکوم میلوئید بعد از پیوند سلول بنیادی آلوژنیک برای سرطان خون میلوئید حاد - هینداوی 2018

Myeloid sarcoma is an extramedullary (EM) manifestation (i.e., manifestation outside the bone marrow) of acute myeloid leukemia (AML); it is assumed to be relatively uncommon and can be the only manifestation of leukemia relapse after allogenic stem cell transplantation (allo-SCT). An EM sarcoma can manifest in any part of the body, although preferentially manifesting in immunological sanctuary sites as a single or multiple tumors. ,e development of myeloid sarcoma after allo-SCT is associated with certain cytogenetic abnormalities, developing of graft versus host disease (GVHD), and treatment with donor lymphocytes infusion (DLI). It is believed that posttransplant myeloid sarcomas develop because the EM sites evade immune surveillance. We present two patients with EM myeloid sarcoma in the breast and epipharynx, respectively, as the only manifestation of leukemia relapse. Both patients were treated with a combination of local and systemic therapy, with successfully longtime disease-free survival. Based on these two case reports, we give an updated review of the literature and discuss the pathogenesis, diagnosis, and treatment of EM sarcoma as the only manifestation of AML relapse after allo-SCT. ,ere are no standard guidelines for the treatment of myeloid sarcomas in allotransplant recipients. In our opinion, the treatment of these patients needs to be individualized and should include local treatment (i.e., radiotherapy) combined with systemic therapy (i.e., chemotherapy, immunotherapy, DLI, or retransplantation). ,e treatment has to consider both the need for sufficient antileukemic efficiency versus the risk of severe complications due to cumulative toxicity.

4. Conclusion

EM posttransplant AML relapse may be more common than previously assumed, and its prognosis remains poor even though possibly slightly better than for combined EM and bone marrow relapse or bone marrow relapse alone. No guidelines for standard treatment of these patients are available, but a common practice is systemic chemotherapy or immunotherapy (i.e., DLI or retransplantation) combined with local radiotherapy. Cumulative toxicities due to previous chemotherapy and the risk of suppressing clinically relevant antileukemic immune reactivity have to be considered when the treatment of such patients is decided. Our two patients received intensive chemotherapy induction followed by consolidating radiotherapy, and only one of them received DLI; both patients are still alive without relapse. Future studies should focus on the development of diagnostic strategies for earlier detection of EM relapse and the identification of molecular mechanisms (i.e., possible therapeutic targets) behind EM homing of leukemic cells.