Analyzing The Clinical Characteristics Of Myeloid Sarcoma

Objective: To improve our knowledge about the clinical charecteristics of myeloid sarcoma(MS)by analyzing the clinical data of the MS patients in real world and reviewing the related literatures.Methods: Collectting the clinical material of MS patients in our hospital scince 2010 by reviewing the medical records and following up visit,that corresponde to patient’s age,gender,symptoms,signs,provil positive and negative lab’s results as blood routine test,biochemistry,bone marrow MICM(Cell morphology,flow cytometry immunophenotype,cytogenetics,Molecular Biology),pathology of bone marrow or MS biopsy,image documents,treatment protocals,comorbidities,and survival outcome.To analyze and describe clinical manifestation characteristics of each MS patient based on literature review.Results: 11 patients diagnosed as MS by pathologic biopsy are enrolled in this study,with 7 males and 4 females,the gender ratio of male: female 1.75:1 and the median age 48(24-74)years.Meeting to the criteria of 2016 WHO revision to classification of myeloid neoplasma and acute leukemia,2 cases of de novol isolated MS,1 case of de novol MS with AML,4 cases of relapse MS after allogenetic hematological stem cell transplantation(allo-HSCT)for prior AML,1 case of relapse MS with prior MDS,1 case of relapse MS after allo-HSCT for prior MDS,1 case of relapse MS after allo-HSCT for prior CML,and 1 case of MS concomitant with refractory CML.MS mass presents in multiple anatomy site in 5 patients and single anatomy site in 6 patients,that involved 22 anatomy site,corespounde to gastroinvestinal tract(36%),soft tissue(22%),eye(14%),bone(14%),breast(7%),vagina(7%).The most common clinical manifestations of myeloid sarcomas are caused by tumor compression,including local pain(abdominal,weist,back,bone and joint),vomiting,vision loss,blindness and weakness,jaundice,etc.The MICM features of MS tissue show: morphologic prodominently monocyteblast with immunophenotyp of 100% of LCA and BCL-2,83.3%of CD68,median 70% of KI67.4/5 of patients showed abnormal karyotype,1 case with t(8;21),3 Case with complex karyotype.6/8 cases displayed abnormal molecular mutations: 2 cases with TP53 mutation,2 cases with BCR/ABL and 1of them concomitant with EV 11,1 case CEBPA bi-allelic mutation,1 case with combined mutations of Run/RUNX1,C-KIT,BCORL1.11 patients received comprehensive individualized treatment,and survival outcome demostred: 4 patients died,2 patients lose vist,5 patients are survived.Conclusion: Myelocytic sarcoma is a rare emergence with complex and heterogeneous clinical manifestations regarding as characteristics of solid and hematologic malignances.The prognositic factors are similar to AML.11 MS patients documented in our hospital in last decade were representive the typical type of myeloid tumors,more than half of them were allo-HCT transplanted patients.5/11 patients are survival at end of this study,which is better outcome than the report in lierature.The MS patients in our observation demostrated the common features as literatures: 1.Patients with isolated MS could be cured or have long-term survival outcome if they receive adequate intensive treatment.2.MS presented in MDS of any stage menifests poor outcome.3.The anatomical site that involved by MS may affect on prognosis of the disease,such as favorable prognosis for MS emerging in female vagina and intestinal.Some de novol characteristics demonstrated in our MS patients: 1.Later relapsed MS patient prognose better than the early relapsed MS patient;2.Higher incident rate of relapse MS in the patient with related-matche-donor allo-HCT.3.Insufficient intensity of chemotherapy or long intervals between treatments are poor factors for MS onsetting.Deficiencies: This is a respective study from a single centra.Few number of patient is restricted for statistic analysis of the related clinical data.The case describing analysis may draw the bias outcome and knowledge.