Extramedullary involvement in pediatric myeloid leukemia: challenges of diagnosis and treatment. Clinical cases and a literature review

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Abstract

   The problem of extramedullary (EM) involvement in acute myeloid leukemia (AML) in children is of considerable relevance since its pathogenesis remains understudied and the impact on prognosis is still unclear. The variability of tissue and organ involvement depends on immunophenotypic, cytogenetic, and molecular features of myeloid cells and can cause difficulties in diagnosis, thus making it necessary to combine imaging and laboratory tools for timely and accurate diagnosis of EM disease. The prognostic significance of EM involvement has not been established unequivocally, thus the need for intensification of chemotherapy, as well as for allogeneic hematopoietic stem cell transplantation in first remission, remain debatable. The results of target therapy in EM AML are encouraging and may reduce the risk of AML relapse. This article describes the clinical features of EM AML in children and reviews the diagnostic approaches as well as the advantages and limitations of existing laboratory and imaging methods. The molecular features of EM AML, current treatment options and prognosis have also been analyzed. The patients' parents gave their consent to the use of their children's data, including photographs, for research purposes and in publications.

About the authors

Yu. V. Dinikina

The Almazov National Medical Research Centre, Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: dinikina_yuv@almazovcentre.ru
ORCID iD: 0000-0002-2003-0982

Yulia V. Dinikina, Cand. Med. Sci., Head of the Department

Department of Chemotherapy for Hematologic Diseases and Bone Marrow Transplantation for Children

197341

2 Akkuratova St.

St. Petersburg

Russian Federation

A. A. Maschan

The Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Healthсare of the Russian Federation

ORCID iD: 0000-0002-0016-6698

Moscow

Russian Federation

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