• Xuehui Zhou and Chengwen Li.
• Department of Hematology, PLA Strategic Support Force Medical Center, Beijing.
• Medicine (Baltimore). 2021 Apr 9; 100 (14): e25257e25257.

RationaleGranulocytic sarcoma (GS) is an extramedullary myeloid tumor composed of immature cells of the granulocytic series. It rarely occurs in acute promyelocytic leukemia (APL). No case of long-term survival in an APL patient with recurrent GS has been reported.Patient ConcernsA 54-year-old female patient was diagnosed with APL in 1995 and has been in complete remission (CR) of bone marrow morphology for 24 years; however, recurrent GS occurred successively in ovary, breast, spine, body of sternum, lymph nodes, soft tissues from 2004 to 2019.DiagnosesThe immunohistochemistry confirmed the diagnosis of GS, and fluorescence in situ hybridization (FISH) revealed its origin from APL.InterventionsShe received surgery, and had an excellent response to all-trans retinoic acid (ATRA), DA (daunorubicin combined with cytarabine) regimens, and arsenic trioxide (ATO).OutcomesThe patient achieved CR in March 2020 after radiotherapy followed by ATO and ATRA. So far, she is still in follow-up.LessonsIt is rare that recurrent GS at multiple sites is involved in APL patient with bone marrow morphology in CR. It is interesting to observe a long-term excellent response to ATRA, chemotherapy and ATO. Although multiple recurrence of GS in patients with APL is rare, the data in this case highlight the need for individualized treatment when such conditions occur.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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