How I treat extramedullary acute myeloid leukemia

Extramedullary (EM) manifestations of acute leukemia include a wide variety of clinically significant phenomena that often pose therapeutic dilemmas. Myeloid sarcoma (MS) and leukemia cutis (LC) represent 2 well-known EM manifestations with a range of clinical presentations. MS (also known as granul...

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Bibliographic Details
Published in:Blood 2011-10, Vol.118 (14), p.3785-3793
Main Authors: Bakst, Richard L., Tallman, Martin S., Douer, Dan, Yahalom, Joachim
Format: Article
Language:English
Subjects:
Biological and medical sciences
Chromosome Aberrations
Drug Therapy
Hematologic and hematopoietic diseases
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myeloid, Acute - complications
Leukemia, Myeloid, Acute - genetics
Leukemia, Myeloid, Acute - pathology
Leukemia, Myeloid, Acute - therapy
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Leukemic Infiltration - complications
Leukemic Infiltration - genetics
Leukemic Infiltration - pathology
Leukemic Infiltration - therapy
Medical sciences
Mutation
Prognosis
Sarcoma, Myeloid - complications
Sarcoma, Myeloid - genetics
Sarcoma, Myeloid - pathology
Sarcoma, Myeloid - therapy
Skin - pathology
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Summary:Extramedullary (EM) manifestations of acute leukemia include a wide variety of clinically significant phenomena that often pose therapeutic dilemmas. Myeloid sarcoma (MS) and leukemia cutis (LC) represent 2 well-known EM manifestations with a range of clinical presentations. MS (also known as granulocytic sarcoma or chloroma) is a rare EM tumor of immature myeloid cells. LC specifically refers to the infiltration of the epidermis, dermis, or subcutis by neoplastic leukocytes (leukemia cells), resulting in clinically identifiable cutaneous lesions. The molecular mechanisms underlying EM involvement are not well defined, but recent immunophenotyping, cytogenetic, and molecular analysis are beginning to provide some understanding. Certain cytogenetic abnormalities are associated with increased risk of EM involvement, potentially through altering tissue-homing pathways. The prognostic significance of EM involvement is not fully understood. Therefore, it has been difficult to define the optimal treatment of patients with MS or LC. The timing of EM development at presentation versus relapse, involvement of the marrow, and AML risk classification help to determine our approach to treatment of EM disease.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2011-04-347229