Clinical significance of granulocytic sarcoma in adult patients with acute myeloid leukemia

To investigate the clinical significance of granulocytic sarcoma (GS) in adults with acute myeloid leukemia (AML), 434 consecutive patients with AML were analyzed retrospectively. Forty‐five patients (10.4%) with GS at diagnosis were younger (P < 0.001), presented with higher white blood cell counts (P = 0.03) and were more likely to conform to French–American–British M4 (P = 0.001) and M5 (P = 0.045) classifications than those without GS. In contrast, no significant difference in frequency of cytogenetic abnormalities was found between the GS and non‐GS groups. Treatment outcomes in 260 patients (40 with GS) who underwent intensive chemotherapy, excluding patients with acute promyelocytic leukemia, were investigated. Complete remission rates did not differ significantly between the GS and non‐GS groups (75.0% vs 79.1%; P = 0.192, respectively) or the 5‐year overall survival (OS) rates (39.9% vs 38.7%; P = 0.749, respectively). However, the GS group had a significantly higher relapse rate than the non‐GS group (74.2% vs 55.3%; P = 0.048) and a significantly lower 5‐year disease‐free survival rate (8.2% vs 25.7%, respectively; P = 0.005). When considered together with the results of multivariate analysis, which identified the presence of GS as an independent predictor for disease‐free survival time, these findings indicate that GS might identify a high‐risk subset of patients with AML. (Cancer Sci, doi: 10.1111/j.1349‐7006.2012.02324.x, 2012)

[1]  T. Naoe,et al.  Randomized study of induction therapy comparing standard-dose idarubicin with high-dose daunorubicin in adult patients with previously untreated acute myeloid leukemia: the JALSG AML201 Study. , 2011, Blood.

[2]  K. Mitani,et al.  Allogeneic stem cell transplantation versus chemotherapy as post-remission therapy for intermediate or poor risk adult acute myeloid leukemia: results of the JALSG AML97 study , 2010, International journal of hematology.

[3]  T. Naoe,et al.  Randomized trial of response-oriented individualized versus fixed-schedule induction chemotherapy with idarubicin and cytarabine in adult acute myeloid leukemia: the JALSG AML95 study , 2010, International journal of hematology.

[4]  T. Yamazaki,et al.  Leukaemia cell mobility in childhood acute myeloid leukaemia based on the FAB classification. , 2009, Scandinavian journal of haematology.

[5]  C. Volteau,et al.  Allogeneic hematopoietic stem-cell transplantation for myeloid sarcoma: a retrospective study from the SFGM-TC. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  T. Dobner,et al.  Myeloid sarcoma in the central nervous system: case report and review of the literature. , 2008, Acta clinica Croatica.

[7]  Rakesh Kumar,et al.  Isolated granulocytic sarcoma of the orbit , 2007, European journal of haematology.

[8]  S. Pileri,et al.  Myeloid sarcoma: clinico-pathologic, phenotypic and cytogenetic analysis of 92 adult patients , 2007, Leukemia.

[9]  W. Rabitsch,et al.  Myeloid sarcoma with multiple lesions of the central nervous system in a patient without leukemia. Case report. , 2006, Journal of neurosurgery.

[10]  H. Shiku,et al.  Granulocytic sarcoma of mesentery in acute myeloid leukemia with CBFB/MYH11 fusion gene but not inv(16) chromosome: case report and review of literature. , 2006, Leukemia research.

[11]  S. Eggener,et al.  Granulocytic sarcoma of the testis. , 2004, Urology.

[12]  R. Hassan,et al.  Granulocytic sarcoma of the small intestine with CBFbeta/MYH11 fusion gene: report of an aleukaemic case and review of the literature. , 2003, Leukemia research.

[13]  J. Biswas,et al.  Chloroma of the orbit in a non-leukemic adult: A case report , 2003, Orbit.

[14]  J. Rossi,et al.  Good outcome of children with acute myeloid leukemia and t(8;21)(q22;q22), even when associated with granulocytic sarcoma , 2000, Cancer.

[15]  M. Tanimoto,et al.  No beneficial effect from addition of etoposide to daunorubicin, cytarabine, and 6-mercaptopurine in individualized induction therapy of adult acute myeloid leukemia: the JALSG-AML92 study. Japan Adult Leukemia Study Group. , 1999, International journal of hematology.

[16]  K Wheatley,et al.  The importance of diagnostic cytogenetics on outcome in AML: analysis of 1,612 patients entered into the MRC AML 10 trial. The Medical Research Council Adult and Children's Leukaemia Working Parties. , 1998, Blood.

[17]  L. Kumar,et al.  Granulocytic Sarcoma of Uterine Cervix as Presentation of Acute Myeloid Leukemia: A Case Report and Review of Literature , 1997, The journal of obstetrics and gynaecology research.

[18]  C. Bloomfield,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. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  J. Byrd,et al.  Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review. , 1995, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  M. Tallman,et al.  Granulocytic sarcoma is associated with the 8;21 translocation in acute myeloid leukemia. , 1993, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  T. Horie,et al.  Myeloblastoma formation in acute myeloid leukemia. , 1992, Leukemia research.

[22]  F. Behm,et al.  Acute myeloid leukemia with T-lymphoid features: a distinct biologic and clinical entity. , 1988, Blood.

[23]  D. Swirsky,et al.  8;21 translocation in acute granulocytic leukaemia: cytological, cytochemical and clinical features , 1984, British journal of haematology.

[24]  H. Gralnick,et al.  Proposals for the Classification of the Acute Leukaemias French‐American‐British (FAB) Co‐operative Group , 1976, British journal of haematology.

[25]  H. Muss,et al.  Chloroma and other myeloblastic tumors. , 1973, Blood.

[26]  D. Mcgregor,et al.  Autopsy study of granulocytic sarcoma (chloroma) in patients with myelogenous leukemia, hiroshima‐nagasaki 1949‐1969 , 1973, Cancer.

[27]  E. Estey,et al.  Investigation of karyotypic, morphologic and clinical features in patients with acute myeloid leukemia blast cells expressing the neural cell adhesion molecule (CD56). , 1994, Leukemia.

[28]  V. Diehl,et al.  Phenotyping of acute myelomonocytic (AMMOL) and monocytic leukemia (AMOL): association of T-cell-related antigens and skin-infiltration in AMOL. , 1989, Leukemia research.

[29]  M. Langenhuijsen,et al.  Motility of leukaemic cells in acute leukaemia related to tumour mass, maturation and FAB classification. , 1988, Acta haematologica.