Maintenance therapy after hematopoietic stem cell transplantation for abdominal myeloid sarcoma: a case report and literature review

Abstract

Objective To observe the efficacy of maintenance treatment with decitabine and dasatinib after allogenic hematopoietic stem cell transplantation for myeloid sarcoma. Methods A 29-year-old male patient was diagnosed with abdominal myeloid sarcoma and acute myeloid leukemia with c-kit mutation and t(8; 21). Allogeneic hematopoietic stem cell transplantation was performed after inducted remission. The conditioning regimen was decitabine + FLAG + modified Bu/Cy. Prophylaxis of GVHD was performed with cyclosporine mycophenolate mofetil and short-term methotrexate. The patient received 11.73×108 mononucleated cells/kg and 17.59×106CD34+ cells/kg from donor. At Day 13 post-transplantation, neutrophils reached 0.5×109/L and platelet count was 20×109/L. Decitabine was prescribed since Day 50 post-transplantation monthly for 5 courses. And dasatinib was offered orally since Day 100 for 4 months. Results It was followed up to 16 months post-transplantation. There were no obvious abnormalities of bone marrow cytology, AML/ETO fusion gene quantification, cerebrospinal fluid or abdominal enhanced computed tomography (CT). Conclusions Hematopoietic stem cell transplantation is an effective treatment for myeloid sarcoma. Decitabine has some efficacy for myeloid sarcoma and it may be used for maintenance treatment after transplantation. Tyrosine kinase inhibitors reduce recurrence in myeloid sarcoma with c-kit mutation. The treatment of decitabine and dasatinib after allogeneic hematopoietic stem cell transplantation yield excellent outcomes. This is the first report in domestic and foreign literatures. Key words: Hematopoietic stem cell transplantation; Myeloid sarcoma; Allogene