Persistent sacral chloroma in refractory acute myelogenous leukaemia

Area of Science:

• Hematology
• Oncology
• Pediatric Oncology

Background:

• Acute myelogenous leukemia (AML) is a cancer of the myeloid line of white blood cells.
• Chloromas, also known as myeloid sarcomas, are extramedullary tumors composed of leukemic cells and are a distinctive manifestation of AML.
• Certain sites like the central nervous system, bone marrow, and testes are recognized sanctuary sites for AML, where the disease can persist despite treatment.

Observation:

• A 14-year-old boy diagnosed with AML presented with multiple chloromas at initial diagnosis.
• While extra-calvarial masses and bone marrow disease responded to chemotherapy, sacral epidural chloromas showed resistance.
• The patient received four courses of chemotherapy, yet the sacral epidural chloromas remained.

Findings:

• This case highlights the potential for chloromas to develop in the sacral epidural space.
• The persistence of sacral epidural chloromas despite multiple chemotherapy courses suggests refractoriness to standard treatment.
• The findings indicate that the sacral spinal canal could represent an additional sanctuary site for acute myelogenous leukemia.

Implications:

• The sacral spinal canal should be considered a potential sanctuary site in pediatric AML with chloromas.
• Further investigation into the unique biology and treatment resistance of chloromas in this location is warranted.
• This case may inform treatment strategies for AML patients presenting with extramedullary disease, particularly in the spinal canal.