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Granulocytic sarcoma

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9 years 8 months ago #1016 by guadalupe
Granulocytic sarcoma was created by guadalupe
Male 36 year-old. Diagnosed with CML, chronic fase on April 2014. Sokal low. Treated with Imatinib 400 mg daily since May 21th. Complete hematological response on June 23th. Three months BCR/ABL 2,29%(August). Six months BCR/ABL 1,61% (November). FISH 2%. Citogenetic non metaphases. On December tumor en left arm (soft tissue). Biopsy Granulocytic sarcoma CD 34+. Periphereal blood BCR/ABL 0,85% (01/22/2015). He is in complete hematologycal response. New cytogenetic and mutacioanl analisis pending results. He has histocompatible sibling.
Which is the better treatment for this patient?
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  • Devendra Hiwase
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9 years 7 months ago #1026 by Devendra Hiwase
Replied by Devendra Hiwase on topic Granulocytic sarcoma
It seems that this patient developed extramedullary disease progression:
My suggestions would be:
1) Further investigations including a) PET scan b) immunophenotype of granulocytic sarcoma cells and c) chasing the result of mutation studies d).If mutation studies are not done on the tissue sample, can they perform on the tissue sample?
2) If there is no other focal extramedullary disease then local RT plus sibling allogeneic stem cell transplantation, I would consider changing TKI therapy to dasatinib if there is no dasatinib resistant mutation
Devendra
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  • jeff lipton
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9 years 7 months ago #1027 by jeff lipton
Replied by jeff lipton on topic Granulocytic sarcoma
By definition, the presence of a granulocytic sarcoma means blast crisis. Therefore, this person has progressed on therapy and the initial Sokal and the molecular improvement should not define the future treatment. Patient needs at least a change in TKI, and perhaps chemotherapy plus new TKI, after reassessment. Morphology of the GS may also be important. If it is just chronic CML appearing, then new TKI alone may be adequate. If it actually looks like myeloid or lymphoid acute leukemia, then I would seriously suggest chemo plus TKI. Dasatinib is appropriate. Local radiation if that is the only site makes sense. Stem cell allografting whether this is related or unrelated needs to be done if the option exists. Also consider post allograft TKI as well.
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  • Pankaj Malhotra
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9 years 7 months ago #1028 by Pankaj Malhotra
Replied by Pankaj Malhotra on topic Granulocytic sarcoma
For sake of argument...if the predominant cell in sarcoma is blast..it is regarded as blastic phase. If it is just collection of granulocytic series of cells..would it still be called as blastic phase?

See the first post on this discussion forum (4 years, 3 months ago!!)
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