title: Leukemic gingival infiltrate as an indicator of chemotherapeutic failure following monoclonal antibody therapy: a case report.
abstract: Treatment options are limited for patients with relapsed acute myelogenous leukemia (AML), particularly when the disease is refractory to standard cytotoxic chemotherapy. Targeted drug therapy offers the advantage of delivering higher doses of non-cross resistant chemotherapy with potentially less systemic toxicity. Gemtuzumab ozogamicin (Mylotarg, Wyeth-Ayerst Laboratories) is an immunoconjugate that consists of humanized anti-CD 33 antibody linked to the potent anti-tumor antibiotic calicheamicin and has been an effective therapy for some patients with relapsed AML. However, the overall utility of gemtuzumab ozogamicin is not well defined. For instance, it is not known how well this antibody will target extramedullary disease. This article reports gemtuzumab treatment of refractory AML in a 32-year-old man. At the time of recurrence, his bone marrow was hypoplastic and without leukemia, but the condition progressed resulting in marked leukemic infiltration of the oral mucosa. This case history raises the possibility that leukemic sanctuary sites may exist, and that monoclonal antibody therapy may have sub-optimal activity in non-medullary sites of disease.
authors.affiliation: Division of Oral Medicine, School of Dental Medicine, 4001 Spruce Street, University of Pennsylvania, Philadelphia, PA 19104, USA. tps@pobox.upenn.edu
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Sollecito
authors.forename: Julia
authors.initials: J
authors.lastname: Draznin
authors.forename: Ernesta
authors.initials: E
authors.lastname: Parisi
authors.forename: Kathleen
authors.initials: K
authors.lastname: Duffy
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: Selina M
authors.initials: SM
authors.lastname: Luger
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Schuster
authors.forename: Donald
authors.initials: D
authors.lastname: Tsai
authors.forename: David L
authors.initials: DL
authors.lastname: Porter
mesh_terms: D000328:Adult; D000617:Aminoglycosides / Q000627:therapeutic use*; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D017809:Fatal Outcome; D000079982:Gemtuzumab; D005881:Gingiva / Q000473:pathology*; D006801:Humans; D000922:Immunotoxins / Q000627:therapeutic use*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology*; D017254:Leukemic Infiltration; D008297:Male; D063268:Sialic Acid Binding Ig-like Lectin 3; D017211:Treatment Failure
chemical_list: D000617:Aminoglycosides; D000903:Antibiotics, Antineoplastic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; C571163:CD33 protein, human; D000922:Immunotoxins; D063268:Sialic Acid Binding Ig-like Lectin 3; D000079982:Gemtuzumab