LETTER

Hippokratia 2012, 16, 4: 390

Neanidis K1, Stylianidou S2, Chatzigiannaki A3, Bousbouras P3, Pantoura M2, Pistevou-Gompaki K2
1
Department of Medical Oncology, 424 General Military NATO Hospital,  2Department of Radiation Oncology, 3Department of Medical Physics, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece

 

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Keywords:  Chloroma, Leukemia, Radiotherapy, Palliative.

Correspoding author: Professor Kiriaki Pistevou-Gompaki, Department of Radiation Oncology, AHEPA Hospital, Aristotle University, Thessaloniki, Greece, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Dear Editor,

We would like to present the experience of our department concerning the excellent result of radiation therapy in the palliative management of Chloroma. Chloroma, also known as granulocytic sarcoma, is a rare extramedullary tumor composed of immature granulocytic cells1-3. It coined “Chloroma” because of its green color. Chloromas are reported in 2.5%-9.1% of patients with acute myeloid leukemia and are often associated with a poor prognosis1,3. The most common locations of Chloroma are skin, soft tissue, bone, periosteum and lymph nodes1-3.

We have the experience of two patients with Chloroma who underwent a palliative course of radiation therapy in Radiation Oncology department of Aristotle University of Thessaloniki. The first patient was a 49-year-old woman presented with severe pain and edema in her right leg. The patient underwent imaging investigations which revealed several masses on sternum, left sacral bone, 5th lumbar vertebra and right inguinal region. The biopsy of the sternum revealed a myeloid sarcoma. The patient received a course of radiation therapy to 2000 Gy in 5 fractions to the right inguinal and demonstrated significant clinical response with a great relief of her symptoms. The second patient was a 70-year-old woman who presented with swelling of her right neck and supraclavicular region. The patient underwent a biopsy of the mass which revealed a myeloid sarcoma. She received a course of radiation therapy to 2000 Gy in 5 fractions and demonstrated a significant clinical response with complete remission of the masses.

The role of radiation therapy in the management of Chloroma is important and many authors in the literature support this method1-5. Low doses of radiation may have excellent results in disease control and symptom relief1,3.

References

1. Bakst R, Jakubowski A, Yahalom J. Recurrent neutrotropic chloroma: report of a case and review of the literature. Adv Hematol. 2011; 2011: 854240.
2. Bakst R, Wolden S, Yahalom J. Radiation therapy for chloroma (Granulocytic Sarcoma). Int J Radiat Oncol Biol Phys. 2012; 82: 1816-1822.
3. Bakst RL, Tallman MS, Douer D, Yahalom J. How I treat extramedullary acute myeloid leukemia. Blood. 2011; 118: 3785-3793.
4. Lan TY, Lin DT, Tien HF, Yang RS, Chen CY, Wu K. Prognostic factors of treatment outcomes in patients with granulocytic sarcoma. Acta Haematol. 2009; 122: 238-246.
5. Pacilli L, Lo Coco F, Ramadan SM, Giannì L, Pingi A, Remotti D, et al. Promyelocytic sarcoma of the spine: a case report and review of the literature. Adv Hematol. 2010; 2010: 137608.