title: Granulocytic sarcoma of the stomach: relapse after hematopoietic stem-cell transplantation for chronic myeloid leukemia.
abstract: 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.
authors.affiliation: Hospital das Clinicas e Faculdade de Medicina da Universidade Federal de Minas Gerais, Minas Gerais, Brazil. antoniovmac@hotmail.com
authors.forename: Antonio Vaz
authors.initials: AV
authors.lastname: Macedo
authors.forename: Izabela F
authors.initials: IF
authors.lastname: Freitas
authors.forename: Faì Bio M
authors.initials: FB
authors.lastname: Oliveira
authors.forename: Clarissa
authors.initials: C
authors.lastname: Resende
authors.forename: Claì Udia Maria C
authors.initials: CU
authors.lastname: Mendes
authors.forename: Ana Karine
authors.initials: AK
authors.lastname: Vieira
authors.forename: Luì Cia P
authors.initials: LC
authors.lastname: Castro
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Rego
authors.forename: Nelma Cristina D
authors.initials: NC
authors.lastname: Clementino
authors.forename: Henrique
authors.initials: H
authors.lastname: Bittencourt
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001549:Benzamides; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000068877:Imatinib Mesylate; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000473:pathology / Q000628:therapy*; D008297:Male; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000473:pathology; D010879:Piperazines / Q000008:administration & dosage*; D011743:Pyrimidines / Q000008:administration & dosage*; D023981:Sarcoma, Myeloid / Q000188:drug therapy / Q000473:pathology; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology; D014184:Transplantation, Homologous
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate