Researchers from France have reported that approximately one-third of all patients with myeloid sarcoma (granulocytic sarcoma, choloroma) become long-term disease-free survivors following allogeneic stem cell transplantation. The details of this study appeared in the October 20, 2008 issue of the Journal of Clinical Oncology.¹

Myeloid sarcoma in an accumulation of myeloblasts in tissues outside the bone marrow in patients with acute myeloid leukemia (AML). Myeloid sarcoma can occur prior to, concomitant with or after the diagnosis of AML. The presence of myeloid sarcoma is usually taken as an adverse prognostic finding independent of other risk factors. If this occurs prior to the diagnosis of AML, such patients usually are treated as if they had AML with induction chemotherapy and consolidation. The relative rarity of this complication of AML precludes a definitive definition of optimal care.

Researchers involved in the current study reported the outcomes of 51 patients with myeloid sarcoma treated with an allogeneic stem cell transplant. The average age of the entire group was 29 years (2.2-53) and 14 of the patients were children. Six patients had an isolated myeloid sarcoma without evidence of AML, 19 had simultaneous AML and myeloid sarcoma, and 26 has a previous history of AML. Forty of the 51 patients had only a single site of disease. Twenty-one patients were in first remission of AML and the remainder had more advanced disease. Thirty patients received stem cells from related donors and 21 from unrelated donors. Thirty-one patients received conditioning regimens containing total-body irradiation. The median time from diagnosis of AML to transplant was 8 months. Median follow-up was 33 months.

The 5-year disease-free survival was 36%, with an overall survival of 47%. Treatment-related mortality was 22% and the relapse rate was 39%. Patients younger than 15 years did very poorly, with only one survival in 14. Complete remission status at the time of transplant was associated with improved outcome. These authors conclude that allogeneic stem cell transplantation can be an effective treatment modality for myeloid sarcoma, but cannot conclude that this is the optimal approach.

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Reference:

¹ Chevallier P, Mohty M, Lioure B, et al. Allogeneic hematopoietic stem-cell transplantation for myeloid sarcoma: A retrospective study from the SFGM-TC. Journal of Clinical Oncology 2008;26:4940-4943.