Browsing by Subject "Myeloid Leukemia"

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    Colonic Myeloid Sarcoma as a Rare Presentation of Relapsed Acute Myeloid Leukemia
    (Wolters Kluwer, 2020-06-15) Phatharacharukul, Parkpoom; Fayad, Nabil; Siwiec, Robert; Medicine, School of Medicine
    Myeloid sarcoma (MS), an extramedullary tumor of immature granulocytic cells, affects the gastrointestinal tract in approximately 10% of cases. MS involvement of the colon and rectum is considered to be extremely rare. We present a 36-year-old woman with acute myeloid leukemia and allogenic hematopoietic stem cell transplant 2 years before who was admitted with abdominal pain and nonmucous, nonbloody diarrhea. Colonoscopy revealed an ulcerated mass in the proximal colon, and biopsies showed MS compatible with acute myeloid leukemia relapse.
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    Dipeptidyl Peptidase 4 Inhibition for Prophylaxis of Acute Graft-versus-Host Disease
    (Massachusetts Medical Society, 2021-01-07) Farag, Sherif S.; Zaid, Mohammad Abu; Schwartz, Jennifer E.; Thakrar, Teresa C.; Blakley, Ann J.; Abonour, Rafat; Robertson, Michael J.; Broxmeyer, Hal E.; Zhang, Shuhong; Medicine, School of Medicine
    Background: Dipeptidyl peptidase 4 (DPP-4; also known as CD26), a transmembrane receptor expressed on T cells, has a costimulatory function in activating T cells. In a mouse model, down-regulation of CD26 prevented graft-versus-host disease (GVHD) but preserved graft-versus-tumor effects. Whether inhibition of DPP-4 with sitagliptin may prevent acute GVHD after allogeneic stem-cell transplantation is not known. Methods: We conducted a two-stage, phase 2 clinical trial to test whether sitagliptin plus tacrolimus and sirolimus would reduce the incidence of grade II to IV acute GVHD from 30% to no more than 15% by day 100. Patients received myeloablative conditioning followed by mobilized peripheral-blood stem-cell transplants. Sitagliptin was given orally at a dose of 600 mg every 12 hours starting the day before transplantation until day 14 after transplantation. Results: A total of 36 patients who could be evaluated, with a median age of 46 years (range, 20 to 59), received transplants from matched related or unrelated donors. Acute GVHD occurred in 2 of 36 patients by day 100; the incidence of grade II to IV GVHD was 5% (95% confidence interval [CI], 1 to 16), and the incidence of grade III or IV GVHD was 3% (95% CI, 0 to 12). Nonrelapse mortality was zero at 1 year. The 1-year cumulative incidences of relapse and chronic GVHD were 26% (95% CI, 13 to 41) and 37% (95% CI, 22 to 53), respectively. GVHD-free, relapse-free survival was 46% (95% CI, 29 to 62) at 1 year. Toxic effects were similar to those seen in patients undergoing allogeneic stem-cell transplantation. Conclusions: In this nonrandomized trial, sitagliptin in combination with tacrolimus and sirolimus resulted in a low incidence of grade II to IV acute GVHD by day 100 after myeloablative allogeneic hematopoietic stem-cell transplantation.