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Isolated Chloroma: The Effect of Early Antileukemic Therapy

Kevin R. Imrie, MD, FRCPC; Michael J. Kovacs, MD, FRCPC; Debbie Selby, MD, FRCPC; Jeffrey Lipton, MD, FRCPC; Bruce J. Patterson, MD, FRCPC; Dominic Pantalony, MD, FRCPC; Peeter Poldre, MD, FRCPC; Bo-Yee Ngan, MD, FRCPC; and Armand Keating, MD, FRCPC

1 September 1995 | Volume 123 Issue 5 | Pages 351-353

Objective: To evaluate the effect of antileukemic chemotherapy administered at diagnosis on the survival of patients with isolated chloroma.

Design: Retrospective review of locally identified patients and analysis of cases from the medical literature.

Patients: The records of all patients with isolated chloroma identified at three teaching hospitals in Toronto between 1980 and 1994 were reviewed. A MEDLINE search was done to identify all cases of isolated chloroma reported in the English-language medical literature. Patients with a previous known hematologic disorder were excluded.

Measurements: The effect of therapy on 1) the interval between diagnosis of chloroma and diagnosis of acute myeloid leukemia and 2) survival was determined.

Results: 7 local patients and 83 published cases were identified, for a total of 90 evaluable patients. For the entire group, the median time to the diagnosis of acute myeloid leukemia was 9 months, and median survival was 22 months. Chemotherapy was administered to 49 patients (54%) at diagnosis of chloroma. Significantly fewer patients treated with chemotherapy subsequently developed acute myeloid leukemia (41% compared with 71%; P = 0.001). Survival was longer in patients treated with chemotherapy (> 50% alive with a median follow-up of 25 months compared with a median survival of 13 months for those initially untreated; P = 0.001). Multivariate analysis showed that neither local radiotherapy nor surgery had an effect on survival.

Conclusions: Administration of antileukemic chemotherapy at diagnosis of chloroma is associated with a significantly lower probability of developing acute myeloid leukemia and with longer survival.

Author and Article Information

From The Toronto Hospital and Princess Margaret Hospital, Toronto, Canada; Victoria Hospital, London, Canada; and Sunnybrook Health Science Centre, North York, Canada.
Grant Support: In part by a Zeneca/Medical Research Council of Canada Research Fellowship (Dr. Imrie) and a Senior Cancer Research Scientist Career Award from the National Cancer Institute of Canada (Dr. Keating).
Requests for Reprints: Dr. A. Keating, The Toronto Hospital, General Division, 200 Elizabeth Street, MLW 2-036, Toronto, Ontario, M5G 2C4, Canada.
Current Author Addresses: Drs. Imrie, Selby, Poldre, and Ngan: Sunny-brook Health Science Centre, 2075 Bayview Avenue, North York, Ontario, M4N 3M5, Canada.

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