Fujii H, Iwai T, Ueda Y, Nakagawa H
Department of Hematology, Kyoto First Red Cross Hospital.
Rinsho Ketsueki. 2000 Dec;41(12):1267-72.
We report a case of Hodgkin's disease that developed 4 years after autologous peripheral blood stem cell transplantation (PBSCT). The patient, a 67-year-old Japanese male, underwent PBSCT for multiple myeloma (IgA-lambda type) under a conditioning regimen of carboplatin, etoposide and cyclophosphamide in June 1994 and obtained partial remission. In January 1995, he underwent a second PBSCT under a conditioning regimen of high-dose melphalan and obtained complete remission. In December 1998, he noticed swelling of the left cervical lymph nodes, and Hodgkin's disease of the mixed cellularity subtype was diagnosed from a lymph node biopsy sample. Immunohistochemistry studies showed that the Hodgkin's and Reed-Sternberg cells were CD30-positive. In situ hybridization using EBER probes showed that these cells expressed EBER RNA transcripts, indicating that the tumor was associated with Epstein-Barr virus. One noteworthy feature was the absence of both M-component in the serum and urine, as revealed by immunoelectrofixation, and plasmacytosis in the bone marrow, which would have indicated relapse of the multiple myeloma. After chemotherapy with MOPP and ABVD, the Hodgkin's disease was eradicated and the patient obtained complete remission in May 1999.
我们报告一例霍奇金淋巴瘤，其在自体外周血干细胞移植（PBSCT）4年后发生。该患者为一名67岁的日本男性，于1994年6月在卡铂、依托泊苷和环磷酰胺预处理方案下接受了多发性骨髓瘤（IgA-λ型）的PBSCT，并获得部分缓解。1995年1月，他在大剂量美法仑预处理方案下接受了第二次PBSCT并获得完全缓解。1998年12月，他注意到左颈部淋巴结肿大，经淋巴结活检样本诊断为混合细胞型霍奇金淋巴瘤。免疫组织化学研究显示霍奇金和里德-斯腾伯格细胞CD30阳性。使用EBER探针的原位杂交显示这些细胞表达EBER RNA转录本，表明肿瘤与爱泼斯坦-巴尔病毒有关。一个值得注意的特征是，免疫电固定显示血清和尿液中均无M成分，骨髓中也无浆细胞增多，而这原本可能提示多发性骨髓瘤复发。经MOPP和ABVD化疗后，霍奇金淋巴瘤被根除，患者于1999年5月获得完全缓解。
