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Case Reports in Hematology
Volume 2015 (2015), Article ID 728260, 6 pages
Case Report

Successful Treatment of Multifocal Histiocytic Sarcoma Occurring after Renal Transplantation with Cladribine, High-Dose Cytarabine, G-CSF, and Mitoxantrone (CLAG-M) Followed by Allogeneic Hematopoietic Stem Cell Transplantation

1Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, San Diego, CA, USA
2Division of Hematology-Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA
3Department of Pathology, University of California San Diego, San Diego, CA, USA
4Blood and Marrow Transplantation Program, Moores Cancer Center, 3855 Health Sciences Drive, No. 0960, La Jolla, CA 92093-0960, USA

Received 22 March 2015; Accepted 31 May 2015

Academic Editor: Ray Lowenthal

Copyright © 2015 Julia Tomlin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Histiocytic sarcoma (HS) is a rare, aggressive malignancy. Lesions previously called HS were typically non-Hodgkin lymphomas, not HS. As such, chemotherapy directed at lymphoid neoplasms was frequently successful, but it is unclear if these regimens are ideal for HS. We present a 33-year-old African gentleman who underwent sequential renal transplants for glomerulonephritis. He subsequently developed HS of the upper airway and multiple cutaneous sites. The patient received cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) followed by salvage ifosfamide, carboplatin, and etoposide (ICE) but had continuous progression of cutaneous involvement. Cladribine, high-dose cytarabine, G-CSF, and mitoxantrone (CLAG-M) yielded a partial response with near resolution of disease. Ultimately, the patient achieved a complete remission after myeloablative allogeneic hematopoietic stem cell transplant. HS occurring after solid organ transplant raises the possibility of HS as a potential posttransplant malignancy. The use of CLAG-M has not been reported in HS. In this case, histiocyte-directed chemotherapy with CLAG-M was superior to lymphoma-directed regimens.