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

Figure 4

(a, b, and c) Photographs of a pre-CLAG-M, post-CLAG-M, and postallogeneic hematopoietic cell transplant skin lesion. (d, e, and f) Maximum intensity projection from positron emission tomography (PET) of upper body and lower extremity. Images correspond with timing of skin lesions photographed in (a)–(c). (d) After CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and salvage ifosfamide, carboplatin, etoposide (ICE) there was progression of skin disease with innumerable cutaneous foci on PET. (e) Following CLAG-M therapy, near resolution of skin lesions. PET demonstrated improvement in cutaneous foci consistent with response to therapy. (f) Five months following allogeneic hematopoietic cell transplant there is no evidence of metabolically active tumor.