Leukemia research · 2026
Clinicopathological stratification of myeloid sarcoma: Differences between acute leukemia-associated, chronic myeloid neoplasm-associated, and de novo disease - A single-center study of 126 cases.
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Agarwal Arti, Chohan Shikhar, Bharti Dipika, Kumar Manish, Singh Sanjeev Kumar, Aggarwal Roopak, Joshi Himanshu, Yadav Neha
Аннотация
BACKGROUND: Myeloid sarcoma is a rare extramedullary tumor of immature myeloid cells, most commonly associated with acute leukemia, but also seen in chronic myeloid neoplasms or as an isolated lesion (de novo). These different clinical contexts suggest biological heterogeneity with potential prognostic implications. This study aimed to analyze clinicopathological features and survival outcomes across these three subgroups in a large single-center cohort.
METHODS: This retrospective study included 126 histologically confirmed cases of myeloid sarcoma diagnosed at UPUMS Saifai between January 2024 and April 2026. Cases were stratified into acute leukemia-associated (EMMT-AL), chronic myeloid neoplasm-associated (EMMT-CMN), and de novo groups. Clinicopathological features, immunohistochemical profiles, and survival outcomes were analyzed using Kaplan-Meier and Cox regression analyses.
RESULTS: Among 126 cases, 68 (54.0%) were EMMT-AL, 36 (28.6%) were EMMT-CMN, and 22 (17.5%) were de novo. The cohort comprised 84 males (66.7%) and 42 females (33.3%). Median age was 35 years (range: 1-78). Site distribution varied significantly: nodal involvement predominated in EMMT-CMN (58.3%), while head and neck region was most common in EMMT-AL (29.4%) and de novo (22.7%) groups. The blastic variant was the most frequent histologic subtype (54.8%). The 2-year overall survival for the entire cohort was 38.5%, with significant differences between groups: 22.1% (EMMT-AL), 67.8% (EMMT-CMN), and 51.2% (de novo) (log-rank p < 0.0001). In EMMT-AL, CD34 expression by immunohistochemistry was associated with inferior overall survival (p = 0.024). In EMMT-CMN, absence of excess marrow blasts (p = 0.015) and differentiated histologic morphology (p = 0.041) predicted better outcomes.
CONCLUSION: Myeloid sarcoma exhibits distinct clinicopathological and prognostic differences based on underlying hematologic disease. Stratification into acute leukemia-associated, chronic myeloid neoplasm-associated, and de novo categories identifies clinically relevant subgroups with significantly different outcomes.
METHODS: This retrospective study included 126 histologically confirmed cases of myeloid sarcoma diagnosed at UPUMS Saifai between January 2024 and April 2026. Cases were stratified into acute leukemia-associated (EMMT-AL), chronic myeloid neoplasm-associated (EMMT-CMN), and de novo groups. Clinicopathological features, immunohistochemical profiles, and survival outcomes were analyzed using Kaplan-Meier and Cox regression analyses.
RESULTS: Among 126 cases, 68 (54.0%) were EMMT-AL, 36 (28.6%) were EMMT-CMN, and 22 (17.5%) were de novo. The cohort comprised 84 males (66.7%) and 42 females (33.3%). Median age was 35 years (range: 1-78). Site distribution varied significantly: nodal involvement predominated in EMMT-CMN (58.3%), while head and neck region was most common in EMMT-AL (29.4%) and de novo (22.7%) groups. The blastic variant was the most frequent histologic subtype (54.8%). The 2-year overall survival for the entire cohort was 38.5%, with significant differences between groups: 22.1% (EMMT-AL), 67.8% (EMMT-CMN), and 51.2% (de novo) (log-rank p < 0.0001). In EMMT-AL, CD34 expression by immunohistochemistry was associated with inferior overall survival (p = 0.024). In EMMT-CMN, absence of excess marrow blasts (p = 0.015) and differentiated histologic morphology (p = 0.041) predicted better outcomes.
CONCLUSION: Myeloid sarcoma exhibits distinct clinicopathological and prognostic differences based on underlying hematologic disease. Stratification into acute leukemia-associated, chronic myeloid neoplasm-associated, and de novo categories identifies clinically relevant subgroups with significantly different outcomes.