RESUMO
CASE REPORT: We report the first case of orbital myeloid sarcoma that was successfully treated with a standard venetoclax dose of 25%. A 38-year-old man with acute myeloid leukemia (AML) post-haplo-hematopoietic stem cell transplantation (HSCT) presented with a nine-month history of progressive right proptosis and a visual acuity deficit. The patient was treated with venetoclax (100â mg orally on days 1-28), cytarabine (40â mg subcutaneously, days 1-10), and itraconazole (100â mg twice daily orally on days 1-28). MANAGEMENT AND OUTCOME: The present case report shows that using cytochrome P450 (CYP) inhibitors is a helpful strategy to reduce the cost of expensive treatments. DISCUSSION: There are limited data on the use of CYP inhibitors as a strategy to reduce the costs of expensive drugs (i.e. venetoclax). This approach has some advantages over standard dose venetoclax (400â mg/day) such as significantly reduced costs (which is relevant for patients in low-income countries). In this case, we used itraconazole-a potent CYP3A4 inhibitor-which can theoretically reduce the dose to 100â mg/day without losing serum therapeutic concentrations.
Assuntos
Leucemia Mieloide Aguda , Sarcoma Mieloide , Sarcoma , Masculino , Humanos , Adulto , Sarcoma Mieloide/tratamento farmacológico , Itraconazol/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica , Leucemia Mieloide Aguda/tratamento farmacológico , Sarcoma/tratamento farmacológico , Sistema Enzimático do Citocromo P-450/uso terapêuticoRESUMO
Extramedullary manifestations of acute myeloid leukemia (AML), often referred to as myeloid sarcoma (MS), occur relatively commonly in children with newly diagnosed or relapsed AML and have been associated with certain French-American-British morphologies and gene/chromosomal rearrangements. The most common locations of MS include the skin, orbit, skeleton, central nervous system, skin, and gut. Pulmonary MS is uncommon in adults and is extremely rare in children. We report the case of a 19-year-old man with French-American-British M5 AML, who before bone marrow transplant, presented with fever, hypotension, and respiratory symptoms that were ultimately attributed to pulmonary MS.
Assuntos
Transplante de Medula Óssea , Leucemia Monocítica Aguda/terapia , Neoplasias Pulmonares/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Sarcoma Mieloide/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Prognóstico , Sarcoma Mieloide/tratamento farmacológico , Adulto JovemRESUMO
El sarcoma granulicítico primario ginecológico es una rara neoplasia maligna de difícil diagnóstico. En este reporte describimos el caso de una mujer de 27 años con sarcoma granulosítico en ausencia de enfermedad hematológica demostrable. Asimismo, se presenta una revisión de la literatura concerniente al diagnóstico de esta enfermedad.
Primary gynecologic granulocytic sarcoma is a rare malignancy with a complex diagnosis. In this report we describe the case of a 27- year old woman with granulocytic sarcoma in the absence of demonstrable hematologic disease. A review of the literature is also presented, regarding the diagnosis of this diseases.
Assuntos
Feminino , Peroxidase/uso terapêutico , Sarcoma Mieloide/tratamento farmacológicoRESUMO
An 18-year-old male underwent an allogeneic hematopoietic stem cell transplantation (allo-HSCT) for chronic myeloid leukemia (CML) in the first late chronic phase. On day 132, he was readmitted to the hospital with nausea, vomiting and nodular lesions on endoscopy. A diagnosis of granulocytic sarcoma of the stomach was made. Bone marrow cytogenetic analysis for the Philadelphia chromosome and nested polymerase chain reaction for BCR-ABL1 were both negative. Immunosuppression was abruptly discontinued, and by day 180, all gastric lesions had completely disappeared. However, there were histological signs of graft-versus-host disease. The patient developed progressive anorexia and elevated hepatic enzymes, which prompted the reintroduction of cyclosporine. Considering the risk of another relapse, imatinib mesylate (IM) 600 mg/day was started. The patient Is condition improved, and there was no evidence of disease recurrence at 36 months after relapse. Relapse of CML is the commonest cause of treatment failure after allo-HSCT. On rare occasions, a localized extramedullary presentation is seen. Unless properly treated, other extramedullary relapse sites and/or marrow infiltration usually occur. Withdrawal of immunosuppression, along with IM therapy seems to be an acceptable approach in this setting.
Assuntos
Antineoplásicos/administração & dosagem , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Segunda Neoplasia Primária , Piperazinas/administração & dosagem , Pirimidinas/administração & dosagem , Sarcoma Mieloide , Neoplasias Gástricas , Adolescente , Benzamidas , Transplante de Células-Tronco Hematopoéticas , Humanos , Mesilato de Imatinib , Terapia de Imunossupressão/efeitos adversos , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Masculino , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/patologia , Sarcoma Mieloide/tratamento farmacológico , Sarcoma Mieloide/patologia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Transplante HomólogoRESUMO
Granulocytic sarcoma (GS), an uncommon solid extramedullary tumour, should be considered even in the absence of leukaemia, as delay in diagnosis and treatment worsens the prognosis. We present a GS (single humeral bone lesion) in a non-leukaemia patient, treated with intensive AML (Acute Myeloid Leukaemia) chemotherapy and sequential radiotherapy, in complete response 26 months after diagnosis, confirmed by histopathology and without leukaemia progression.