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Vol. 42. Issue S1.
Pages 77 (October 2020)
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Vol. 42. Issue S1.
Pages 77 (October 2020)
PP 76
Open Access
Isolated extramedullary relapse after hematopoietic stem cell transplantation
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Z. Guzelkucuk*, P. Isık, O. Arman Bilir, D. Kacar, A. Koca Yozgat, M. Isık, D. Gurlek Gokcebay, I. Ok Bozkaya, N. Ozbek, N. Yarali
University of Health Sciences, Ankara City Hospital, Department of Pediatric Hematology and Oncology, Ankara, Turkey
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Objective: Isolated extramedullary (EM) relapse of acute leukemia is rare. It is more common in patients who undergo hematopoietic stem cell transplantation (HSCT) than patients receive chemotherapy alone. We aimed to describe the demographic and clinical features, and clinical outcomes of children diagnosed with isolated EM relapse after allogeneic HSCT.

Methodology: Between 2012 and 2020, patients aged <18 years and treated with the diagnosis of isolated EM relapse after HSCT at the Department of Pediatric Hematology and Oncology, Health Sciences University Ankara Pediatric Hematology-Oncology Training and Research Hospital were enrolled in our study. The demographic features, clinical manifestations, treatment, and prognosis were analyzed retrospectively.

Results: Eight patients with extramedullary relapse after allogeneic HSCT were evaluated. Two patients were female, and six patients were male. The mean age of the patients was 9.8 years (min–max value: 12/12–168/12years). The type of leukemia was precursor B acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and chronic myeloid leukemia (CML) in four, two, and two patients respectively. One patient had mass in the left iliac fossa, 1 patient had multiple mass in the right femur distal and tibia, 2 patients had mass in the testis,1 patient had mass head of the femur,1 patient had mass left orbit, 1 patient had central nervous system relapse and mass in the right lateral of the nose, medial part of the sacrum, 1 patient had mass in kidney. All patients had a biopsy-proven histopathological diagnosis. The mean relapse time after HSCTwas 17.3 months (min–max duration; 3–48 months). The mean follow-up time was 41.7 months (min–max: 12–120 months). Four patients died during the follow-up period. One patient; developed severe febrile neutropenia, mucositis attacks, and acute pancreatitis with systemic chemotherapy. After 13 months, HSCT was performed from her other compatible sibling due to medullary relapse, and she is still in remission. Other one patient was treated with systemic chemotherapy and imatinib, donor lymphocyte infusion, and local radiotherapy and continued to be followed in remission. Two patients treated with systemic chemotherapy; however, they had recurrent relapses and still on systemic chemotherapy.

Conclusion: Isolated extramedullary relapse is mostly reported during AML, rarely during other myeloproliferative diseases (CML) and more often in male patients. In our study, male patients were predominant that was similar to the literature. Of interest, four patients with precursor B ALL had isolated EM. Although the survival rates were low in these patients, the mean follow-up time was 41.7 months.

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Hematology, Transfusion and Cell Therapy
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