A case of donor-derived granulocytic sarcoma after allogeneic hematopoietic stem cell transplantation

Abstract

The occurrence of granulocytic sarcoma as a pattern of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. In this paper, we report a rare case of acute myeloid leukemia (AML) relapsed as a granulocytic sarcoma of the donor type. The patient was diagnosed as having AML and underwent an allo-HSCT from his matched sibling donor. Fifty-seven months after allo-HSCT, he developed granulocytic sarcomas of duodenum, jejunum, and left sterno-cleido-mastoid muscle. The bone marrow was normal with 100% donor chimerism. A Y chromosome PCR was performed on the patient's duodenum specimen as well as bone marrow aspirate in order to check the patient-origin cells. The duodenal specimen was found to contain 41.2% SRY-positive cells (from the donor). Repeat endoscopy on day 2 of chemotherapy showed that the granulocytic sarcoma had shrunk dramatically. The patient died of sepsis during the nadir state 35 days after starting salvage chemotherapy.

Keywords: AML; Allo-HSCT; Donor type; Granulocytic sarcoma.

Fig. 1

Endoscopic findings of the duodenal mucosal lesion.

Fig. 2

Infiltrating cells were immunoreactive for CD34. Immunohistochemical stain. ×400.

Fig. 3

Multiplex short tandem repeat polymerase chain reaction performed for the duodenal biopsy specimen shows that 41.2% of the cells were of donor origin.