Successful Treatment of Myeloid Sarcoma in an Elderly Patient with Myelodysplastic Syndrome with Reduced-Dose Azacitidine

Table 1

The clinical characteristics of cases of myeloid sarcoma that were successfully treated with azacitidine.

Case/reported year	Age/sex	Diagnosis at development of MS	Sites of origin	Treatment for MS	Cycles of AZA for MS	Maximum response of AZA for MS	Outcome (cause of death)	Reference
1 (2013)	62/M	CMML type-2	Right humerus	AZA (75 mg/m^2 × 7 days) + RT (25 Gy)	6	Decreased in size	Alive	[8]
2 (2013)	34/M	Monoblastic leukemia cutis	Multiple skin nodules, groin mass	IDR + Ara C followed by allo-HSCT ⟶ CLAG followed by DLI and RT ⟶ a cycle of AZA (32 mg/m^2 × 5 days) ^⟶ 4 cycles of AZA (75 mg/m^2 × 7 days) ⟶ RT	5	Decreased in size	Died (multiorgan failure)	[9]
3 (2013)	39/F	Relapse of AML-M2 after allo-HSCT	Gingiva	FLAG with GO ⟶ FLAG and DLI ⟶ AZA (75 mg/m^2 × 7 days)	17	Clinical resolution	Alive	[9]
4 (2015)	72/M	MDS EB-2	Disseminated skin papules (LC)	36 cycles of AZA (75 mg/m^2 × 5 days) for MDS ⟶ 41 cycles of the same dose of AZA after the onset of LC	41	Pathological resolution	Alive	[10]
5 (2015)	78/M	MDS MLD	Multiple skin lesions (LC)	AZA (75 mg/m^2 × 7 days) ⟶ 6-MP	7	Clinical resolution	Died (N/A)	[10]
6 (2015)	76/M	CMML type-1	Multiple skin lesions (LC)	9 cycles of AZA (75 mg/m^2 × 5 days) for CMML ⟶ 4 cycles of AZA (75 mg/m^2 × 7 days) after the onset of LC	4	Regression of LC	Died (N/A)	[10]
7 (2016)	80/F	MDS ⟶ AML	Left eyelid	CAG ⟶ AZA (75 mg/m^2 × 7 days)	At least 1	Decreased in size	Died (AML progression)	[11]
8 (2017)	71/F	MDS EB-2	Nasopharynx, tonsil, spleen, multiple lymph nodes, skin	DNR + Ara C ⟶ AZA (100 mg/body × 7 days, as maintenance therapy)	20	Skin: clinical and radiological resolution; others: a marked reduction in the FDG uptake on PET-CT	Alive	[12]
9 (2018)	70/F	Therapy-related MDS (MDS-RS-MLD)	Multiple skin lesions (LC)	A cycle of AZA (75 mg/m^2) ⟶ 6 cycles of biomodulatory therapy: AZA (75 mg/body × 7 days), pioglitazone and ATRA	7	Clinical resolution	Died (AML progression)	[13]
10 (present case)	89/M	MDS EB-2	Skin	AZA (37.5 mg/m^2 × 7 days)	16	Clinical resolution	Died (AML progression)	N/A

F: female; M: male; MS: myeloid sarcoma; CMML: chronic myelomonocytic leukemia; MDS: myelodysplastic syndrome; AML: acute myeloid leukemia; EB: excess blasts; AZA: azacitidine; RT: radiotherapy; Ara C: cytarabine; CAG: cytarabine, aclarubicin, and granulocyte colony-stimulating factor (G-CSF); DNR: daunorubicin; FDG: fluorodeoxyglucose; PET-CT: positron emission tomography-computed tomography; N/A: not available; LC: leukemia cutis; MLD: multilineage dysplasia; IDR: idarubicin; allo-HSCT: allogeneic hematopoietic stem-cell transplantation; CLAG: cladribine, high-dose cytarabine, and G-CSF; DLI: donor lymphocyte infusion; FLAG: fludarabine, high-dose cytarabine, and G-CSF; GO: gemtuzumab ozogamicin; 6-MP: 6-mercaptopurine; MDS-RS: MDS with ring sideroblasts; ATRA: all-trans-retinoic acid. “Ongoing.”