Retrospective study of myeloid sarcoma from tertiary care centre of western india

Objective: Hematological malignancies may present as extramedullary malignant myeloid precursor cell mass in rare cases. Myeloid sarcoma (MS) may associated with acute or chronic leukemia. To discuss clinicopathologicalfeatures and treatment response of myeloid sarcoma(MS) patients at our institute.
Methods: We described the clinicopathologicalfeatures and treatment response of 31 MS patients in the Medical oncology department of Gujarat cancer research institute, ahemdabad, Gujarat, india from January 2010 to december 2015 and the relevant literature. MS patients were treated with systemic chemotherapy using Acute myeloid leukemia (AML)-like regimens only or local treatment (radiation, surgery) with or without systemicchemotherapy using AML-like regimens.
Results: In this study 31 patients aged 6-68years (median: 32years; mean: 35.8years). There were 15 male and 16 female with a ratio of 0.9:1. The MS occurrence was most common at the lymphnodes (N=7, 22.6%), followed by Bones (N=5, 16.13%) and orbit (N=5, 16.13%) and reproductive organs (N=3, 9.70%). The MS of 5 patients (16.13%) were associated with AML, 5 (16.13%) patients were associated with CML and 21(67.74%) patients had de novo isolated MS. Twelve patients (38.71%) were treated with surgery and/or radiotherapy, chemotherapy (SRC) and nineteen (61.29%) with chemotherapy (C). Sixteen patients (51.61%) achieved a complete remission (CR), ten (32.26%) achieved a partial remission(PR), and five(16.13%) had progression. After treatment, the number of patients who achieved a CR was lower in the C group (N=8, 42.11%) than in the SRC group (N=8, 66.67) (P =0.035). On follow-up, two patients in the SRC group and four in the C group died (P =0.72). Survival for SRC and C treatment group was 83.3% and 78.9% respectively (P=0.0328) and 36 months in both groups.
Conclusion: The combined application of histopathology, immunohistochemistry and imaging are required to diagnose MS. Induction chemotherapy or tyrosine kinase inhibitor (imatinib) administered as early as possible. Surgery and/or radiotherapy administered to symptomatic lesions or tumors causing organ obstruction. Prospective controlled trials are required to describe characteristics of MS and role of targeted treatment.