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How would you treat a diffuse CNS myeloid sarcoma (aka chloroma/granulocytic sarcoma) without evidence of blood or bone marrow involvement?
The patient has no medical problems and no history of leukemia/MDS. Biopsy of the filum terminale and arachnoid confirmed a myeloid sarcoma and MRI showed diffuse involvement of the leptomeninges from brain down to cauda equina without parenchymal brain or spine involvement. Bone marrow biopsy, CSF, and peripheral blood were negative so it appears to be isolated CNS involvement. She is symptomatic with headache, paresthesias, and lower extremity weakness. What is the role for radiotherapy in this case? Which systemic therapy regimen would you recommend?
Answer from: Medical Oncologist at Academic Institution
Myeloid sarcoma prognosis is not good and treatment need high dose ARA-C based chemo As induction. Would consider IT chemo would consider Omaha as well. Patient will need after CR CS radiation inculded in the conditioning regimen to consolidate with Myeloablative transplant. HLA and donor acti...
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Answer from: Radiation Oncologist at Academic Institution
Isolated myeloid sarcoma is a very rare condition effecting perhaps 1% of all pts with AML, so any therapeutic recommendations are merely educated guesses. Probably the best approach is some combination of systemic and local therapy (see MD Anderson report Leukemia 1&:1100, 2003) sin...
Answer from: Radiation Oncologist at Community Practice
Careful pathology review is essential in confirming this entity given the unusual presentation (make sure this is not ALL). In addition, I would recommend FISH, cytogenetics, and a next gen sequencing for myeloid molecular panel for mutations that could be used to monitor disease progression or poss...