Pediatric Myeloid Sarcoma, More than Just a Chloroma: A Review of Clinical Presentations, Significance, and Biology

Simple Summary Childhood acute myeloid leukemia (AML) remains a cancer with poor overall outcomes. Myeloid sarcomas (MS) are extramedullary masses of leukemia cells that can develop in patients with AML. In children, MS occurs more frequently than described in adults. Their clinical significance in both pediatric and adult patients with AML is unclear. In this review, we aim to summarize the current knowledge of MS in children and its underlying biology in the hopes of sparking future studies and ultimately improving treatment options for children with AML. Myeloid sarcomas (MS), commonly referred to as chloromas, are extramedullary tumors of acute myeloid leukemia (AML) with varying incidence and influence on outcomes. Pediatric MS has both a higher incidence and unique clinical presentation, cytogenetic profile, and set of risk factors compared to adult patients. Optimal treatment remains undefined, yet allogeneic hematopoietic stem cell transplantation (allo-HSCT) and epigenetic reprogramming in children are potential therapies. Importantly, the biology of MS development is poorly understood; however, cell-cell interactions, epigenetic dysregulation, cytokine signaling, and angiogenesis all appear to play key roles. This review describes pediatric-specific MS literature and the current state of knowledge about the biological determinants that drive MS development. While the significance of MS remains controversial, the pediatric experience provides an opportunity to investigate mechanisms of disease development to improve patient outcomes. This brings the hope of better understanding MS as a distinct disease entity deserving directed therapeutic approaches.