I have a young patient who was getting chemotherapy and radiation for relapsed Ewing's sarcoma. The patient started having pancytopenia and a bone marrow aspiration and biopsy showed AML. The patient has just completed induction chemotherapy for AML. I wonder if the patient would benefit from performing a myeloablative allogeneic HSCT. The patient has a fully matched sibling.
This case is secondary leukemia , that one important option is allogenic transplantation
Dear Dr. Payandeh, thank you for your comment. This patient also has metastatic Ewing's sarcoma which is not in remission.
Administration of chemotherapy in myeloablative doses followed by autologous stem cell recon- stitution has been used for patients with Ewing sarcoma met- astatic at initial presentation and for patients following recurrence of Ewing sarcoma.
No regimen has conclusively demonstrated benefıt for this strategy, and most reports are small series that do not adequately control for selection bias.
The European Ewing sarcoma consortium began a trial in 1999 in which all patients received common initial therapy. Patients with lung metastases at initial presentation or pa- tients with poor response to initial therapy were randomly assigned to either continue conventional chemotherapy or undergo consolidation with high-dose therapy and autolo- gous stem cell reconstitution.
As of 2014, the results of this study remained blinded because the accrual goals set at study initiation had not been met.
When Ewing sarcoma recurs following initial therapy, the prognosis is extremely poor, with less than 5% of patients re- maining alive more than 2 years following recurrence (Asco 2015).
Some report in EBMT explain about the GVL In Ewing sarcoma, but in the last report die to high mortality recently not recommended.
in this case we need potent myelo ablation and I think that with this selection we can treat two disease together with myelo ablation for active sarcoma disease and GVL for AMl.
In my opinion this is a case for myeloablative conditioning regimen and allo SCT.
Dear Palma,
The patient had had two lines of chemotherapy and radiation for Ewing's including doxorubicine, vincristine, cyclophosphamide, irinotecan and temozolomide. Her t-AML was diagnosed while the patient was receiving radiation to the lungs for pulmonary metastasis. Bone marrow aspirate and biopsy showed about 50% blasts and the bone marrow was positive for MLL by FISH. The bone marrow was negative for NPM,FLT3, and CEBPA.
Dear Palma,
Thank you for your feedback. I know about the application of allogeneic stem cell transplant for the management of the patient's t-AML. The patient has metastatic Ewing's sarcoma. One year survival for this condition is not more than10-15%. Can the patient benefit from an allo transplant? There are a couple of reports using allogeneic stem cell transplant for treating metastatic Ewing's.
Dear Palma,
Thank you for your feedback and those references. It is a very unfortunate condition. My patient is young with no comorbidities and has a fully matched sibling.
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