scholarly journals Isolated recurrence of acute myeloid leukemia in the cerebellum: illustrative case

2021 ◽  
Vol 2 (8) ◽  
Author(s):  
Vikraant Kohli ◽  
Michael T. Koltz ◽  
Ashwin A. Kamath
Keyword(s):  
Acute Myeloid Leukemia ◽  
Posterior Fossa ◽  
Myeloid Leukemia ◽  
Case Reports ◽  
Obstructive Hydrocephalus ◽  
Case Series ◽  
Myeloid Sarcoma ◽  
High Dose ◽  
Illustrative Case ◽  
Acute Myeloid

BACKGROUND Myeloid sarcoma is a rare malignant hematopoietic neoplasm that arises at extramedullary sites. Although myeloid sarcoma may involve any organ, central nervous system (CNS) involvement is exceptionally rare. To date, few case reports and case series have described CNS myeloid sarcoma, the majority of which include peripheral disease. OBSERVATIONS The authors present an illustrative case of an adult male with acute myeloid leukemia (AML) in remission relapsing with an isolated, diffuse myeloid sarcoma of the cerebellum. Magnetic resonance imaging showed posterior fossa crowding and diffuse enhancement within the cerebellar white matter without an apparent mass lesion. The patient required ventriculostomy due to obstructive hydrocephalus and ultimately suboccipital craniectomy with duraplasty due to posterior fossa compression. An open cerebellar biopsy revealed myeloid sarcoma. Peripheral studies did not meet the criteria for recurrent AML. The patient subsequently received high-dose systemic chemotherapy and has responded well to treatment. LESSONS Myeloid sarcoma may be a neurosurgical lesion because it has the potential to cause mass effect with obstructive hydrocephalus requiring emergent cerebrospinal fluid diversion and possible decompression. The authors report a rare case of isolated recurrence of AML in the form of diffuse CNS myeloid sarcoma and describe the role of neurosurgery in its diagnosis and treatment.

scholarly journals Acute Myeloid Leukemia in Patients Living with HIV Infection: Several Questions, Fewer Answers

2020 ◽  
Vol 21 (3) ◽  
pp. 1081
Author(s):  
Fabio Forghieri ◽  
Vincenzo Nasillo ◽  
Francesca Bettelli ◽  
Valeria Pioli ◽  
Davide Giusti ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Hiv Infection ◽  
Myeloid Leukemia ◽  
Case Reports ◽  
Case Series ◽  
People Living With Hiv ◽  
Hematopoietic Stem ◽  
Molecular Features ◽  
Living With Hiv ◽  
Acute Myeloid

Both human immunodeficiency virus (HIV) infection and acute myeloid leukemia (AML) may be considered relatively uncommon disorders in the general population, but the precise incidence of AML in people living with HIV infection (PLWH) is uncertain. However, life expectancy of newly infected HIV-positive patients receiving anti-retroviral therapy (ART) is gradually increasing, rivaling that of age-matched HIV-negative individuals, so that the occurrence of AML is also expected to progressively increase. Even if HIV is not reported to be directly mutagenic, several indirect leukemogenic mechanisms, mainly based on bone marrow microenvironment disruption, have been proposed. Despite a well-controlled HIV infection under ART should no longer be considered per se a contraindication to intensive chemotherapeutic approaches, including allogeneic hematopoietic stem cell transplantation, in selected fit patients with AML, survival outcomes are still generally unsatisfactory. We discussed several controversial issues about pathogenesis and clinical management of AML in PLWH, but few evidence-based answers may currently be provided, due to the limited number of cases reported in the literature, mainly as case reports or small retrospective case series. Prospective multicenter clinical trials are warranted to more precisely investigate epidemiology and cytogenetic/molecular features of AML in PLWH, but also to standardize and further improve its therapeutic management.

scholarly journals Adult Case Series of Extramedullary Relapsing Acute Myeloid Leukemia (AML) after Allogeneic Stem Cell Transplantation in Whom a Rapid Response and a Reasonably Long Remission Could be Achieved with Gemtuzumab Ozogamycin (GO)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5129-5129
Author(s):  
Omur Gokmen Sevindik ◽  
Ali Ihsan Gemici ◽  
Furkan Selim Usta ◽  
Asli Çakır ◽  
Sevil Sadri ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Case Series ◽  
Skin Lesions ◽  
Salvage Chemotherapy ◽  
High Dose ◽  
Extramedullary Disease ◽  
Blast Count ◽  
Acute Myeloid

Gemtuzumab Ozogamycin (GO) is a drug conjugated monoclonal antibody which targets CD33 an antigen highly expressed on the surface of AML blasts. GO is approved for the treatment of both newly-diagnosed and relapsed AML. Despite growing evidence regarding its efficacy and safety among AML patients there is limited data about the use of GO in isolated extra-medullary relapsed AML. Extramedullary AML remains as an unmet clinical need regarding the poor prognosis and lack of a standard therapeutic approach. Our cases demonstrated a rapid and long lasting response with a favorable toxicity profile, in patients who were treated with GO as a single agent after an isolated extramedullary relapsing disease. Our first case was a 40-years-old woman admitted to our outpatient clinic with pain in her joints and redness in her back and stomach. She was diagnosed with CD33-positive Acute Myeloid Leukemia according to the immunophenotyping of bone marrow blasts. Idarubicin and ARA-C (7+3) combination initiated as a frontline induction therapy and morphological remission was achieved after the first cycle of induction. After the first cycle of consolidation chemotherapy with high dose ARA-C she has relapsed with skin myeloid sarcomas and diffuse bone marrow infiltration. Soon after the relapsing disease she was put on to ida-flag salvage chemotherapy and she responded well with the disappearance of skin lesions and morphological complete remission of bone marrow. After achieving response, an allogeneic stem cell transplantation (HSCT) was applied from her sibling donor with a myeloablative conditioning. Unfortunately patient had a relapsing extramedullary disease with reappearance of skin lesions even with an ongoing acute skin gvhd (Figure) soon after allogeneic HSCT. Bone marrow biopsy revealed no increase in blast count. We have decided to initiate a novel targetted therapy to control the extramedullary disease. As her blasts infiltrating the skin were universally CD 33 positive we considered to put her on GO therapy with the approval obtained from health authority. GO was applied according to the dosage approved by FDA for relapsing disease. After the first cycle of GO she had a rapid disappearance of all skin lesions just complicated with a febrile neutropenic episode and re-activation of CMV infection which was controlled with Gancyclovir. She has retained a complete remission regarding extramedullary disease throughout the repeated courses of GO for 3 times, and she is still in remission for 4 months after the first appearance of skin lesions (Figure). Our second case was a 24-years-old boy who admitted to our outpatient clinic with a worsening fatigue and shortness of breath. He was also diagnosed with CD33-positive Acute Myeloid Leukemia according to the immunophenotyping of bone marrow blasts and was able to achieve a morphological CR after frontline induction therapy with 7+3 protocol. After two cycles of high dose ARA-C consolidation he was transplanted from a matched unrelated donor because of an intermediate cytogenetic risk profile. At the 14th month of allogeneic transplantation he had relapsed with a bone marrow blast count of 90% and harboring a monosomy on the 10th chromosome. After the first salvage chemotherapy with IDA-FLAG protocol he has achieved a morphological CR and we have decided to proceed with an alternative donor transplantation. But unfortunately soon after discharge, he has admitted to the emergency clinic with a new onset headache and nausea and vomiting. A cranial CT revealed multiple foci of solid masses with peripheral edema. We have performed a lumbar puncture and CSF fluid revealed a high number of CD33 positive blastic cells (over 100 cells per HPF). At the time of central nervous system (CNS) relapse his bone marrow was free of blastic infiltration. We decided to initiate GO treatment with the diagnosis of isolated central nervous system relapse of AML, accompanying intra-thecal chemotherapy via an Omaya Reservoir. He has received two cycles of GO which was complicated with neutropenic fever and grade 4 leukopenia and thrombocytopenia, and his CNS lesions also responded well and clinically he had no CNS related signs or symptoms. The patient received additional GO with continued response but unfortunately after a severe pneumonia he passed away at intensive care unit. Our case series documented a clinically relevant therapeutic field for GO in isolated extramedullary relapse of AML. Disclosures No relevant conflicts of interest to declare.

scholarly journals High-dose cyclophosphamide and etoposide for patients with refractory acute myeloid leukemia: A case series

2003 ◽  
Vol 73 (4) ◽  
pp. 295-296 ◽  
Author(s):  
Jeffrey Talbot ◽  
David A. Rizzieri ◽  
Carlos M. DeCastro ◽  
Joseph O. Moore ◽  
Patrick Buckley ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Case Series ◽  
High Dose ◽  
Refractory Acute Myeloid Leukemia ◽  
Acute Myeloid

Evan’s in a Case of Acute Myeloid Leukemia Post COVID-19 Infection

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Mehta P ◽  
◽  
Kapoor J ◽  
Bansal N ◽  
Tejwani N ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Myeloid Leukemia ◽  
Case Series ◽  
High Dose ◽  
System Disease ◽  
Hematological Manifestations ◽  
Autoimmune Cytopenia ◽  
Acute Myeloid

The Spectrum of Manifestations of COVID-19, A Pandemic Caused By Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although emerged as a respiratory tract infection, is now regarded as a multi- system disease including hematological manifestations such as lymphopenia, thrombocytopenia, disseminated intravascular coagulopathy, COVID-19 associated coagulopathy and autoimmune cytopenia. It has been proposed that proinflammatory state induced by COVID-19 can lead to immune dysregulation and hence autoimmune cytopenia. Various case series have reported autoimmune hemolytic anemia (AIHA) post COVID-19 infection. We are reporting an unusual presentation of evan’s syndrome (Cold Autoimmune Hemolytic Anemia (CAIHA) with immune thrombocytopenia) secondary to COVID-19 in a case of Acute Myeloid Leukemia (AML) on consolidation chemotherapy with high dose cytarabine at our institute. As steroid did not seem to have any major response in our case, it is imperative to have a better understanding to guide the use of immunosuppression in autoimmune complications of SARS-CoV-2. We emphasize that one needs to be vigilant to look for these rare autoimmune manifestations, particularly in patients with underlying immune aberrancies due to their primary disease.

Sustained expression of nucleophosmin (NPM1) mutation at late relapse presenting as isolated myeloid sarcoma in a patient with acute myeloid leukemia

2007 ◽  
Vol 86 (10) ◽  
pp. 763-765 ◽  
Author(s):  
Sebastian Scholl ◽  
Joachim Lüftner ◽  
Lars-Olof Mügge ◽  
Volker Schmidt ◽  
Hans-Jörg Fricke ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Myeloid Sarcoma ◽  
Late Relapse ◽  
Npm1 Mutation ◽  
Acute Myeloid

An Unusual Case Of Disseminated Histiocytic Sarcoma Preceded By Myeloid Sarcoma With Concomitant Acute Myeloid Leukemia

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S107-S108
Author(s):  
A C Reddy ◽  
K S Reddy
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Neck Mass ◽  
Histiocytic Sarcoma ◽  
Myeloid Sarcoma ◽  
Monocytic Differentiation ◽  
Tissue Samples ◽  
Disseminated Disease ◽  
Acute Myeloid

Abstract Introduction/Objective Histiocytic sarcoma (HS) is rare (<1% of hematolymphoid neoplasms), and can present extranodally as disseminated disease. Immunophenotypically, the cells express CD163, CD68, lysozyme and CD45. HS often occurs as a secondary event following B-cell lymphomas, acute lymphoblastic leukemia or acute myeloid leukemia (AML) typically with monocytic differentiation retaining the same molecular/cytogenetic abnormalities as the primary tumor. Results Our patient, a 47 year old male was diagnosed with myeloid sarcoma (MS) following FNA of a new neck mass. A bone marrow biopsy revealed AML without monocytic differentiation. Flow cytometric findings of both marrow and neck mass were similar (positive for CD34, CD117, CD33, CD11b, CD13, CD15, CD64, CD7; negative for CD4, CD14, CD56). Karyotypic and FLT3 ITD mutation analysis were normal. CNS involvement was diagnosed 2 months later, while a marrow biopsy (status post therapy) confirmed resolution of AML. A hypermetabolic left perinephric mass noted by PET CT, when biopsied, showed large epithelioid polygonal cells with amphophilic cytoplasm and atypical vesicular nuclei (positive for CD68, PU.1; negative for LCA, CD163, CD34, CD4, pankeratin). A diagnosis of atypical epithelioid neoplasm suggestive of HS was rendered, although negativity for LCA and CD163 was unusual. No treatment was given for HS. A month later, the patient presented with a cheek mass diagnosed again as being suggestive of HS. His AML also relapsed. Next-generation sequencing (37 genes including BRAF) from both marrow and tissue samples detected the presence of a nonsense mutation in exon 7 of WT1 (p.Ser169). Conclusion Our case appears to be the first reported one of disseminated HS preceded by MS and concomitant AML, lacking monocytic differentiation. The findings overall support the hypothesis of origin as being from a common progenitor cell differentiating along both myeloid and histiocytic/other cell lineages at different time points.

scholarly journals Isolated Gastric Myeloid Sarcoma: A Case Report and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Pankit Vachhani ◽  
Prithviraj Bose
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Case Report ◽  
Myeloid Leukemia ◽  
Bone Marrow Involvement ◽  
Myeloid Sarcoma ◽  
Review Of The Literature ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Acute Myeloid

Myeloid sarcoma represents the proliferation of myeloblasts of acute myeloid leukemia (AML) at extramedullary sites. While extramedullary involvement in AML is uncommon in itself, isolated myeloid sarcomas, that is, myeloid sarcomas without any bone marrow involvement, are extremely rare and pose a diagnostic and therapeutic challenge. Here, we present the case of a middle-aged woman with isolated myeloid sarcoma in the stomach—an organ seldom involved by this disease. Additionally, the literature on the epidemiology, diagnosis, pathology, prognosis, and therapeutic options in myeloid sarcomas has been reviewed.

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