Nishii K, Katayama N, Chen F, Usui E, Kadowaki S, Mitani H, Masuya M, Kageyama S I, Kita K, Shiku H
The Second Department of Internal Medicine, Mie University School of Medicine, Tsu, Mie, Japan.
Bone Marrow Transplant. 2001 Mar;27(5):555-8. doi: 10.1038/sj.bmt.1702817.
We report a case of a patient with IgA kappa multiple myeloma (MM) mobilized with etoposide and subsequently receiving high-dose melphalan (HDM) with stem cell support. She relapsed rapidly post transplantation. Southern blot and fluorescent in situ hybridization analysis showed MLL gene rearrangement in the myeloma cells, which was not detected in the sample at diagnosis or in the PBSC harvested with etoposide plus G-CSF. These observations suggest that clonal rearrangement of the MLL gene is caused by etoposide. Patients with MM undergoing HDM with stem cell rescue may be at an increased risk of not only secondary leukemia, but also secondary genetic abnormalities in myeloma cells, especially those receiving priming with etoposide for peripheral blood stem cell collection.
我们报告了一例IgA κ型多发性骨髓瘤（MM）患者，该患者使用依托泊苷进行动员，随后接受了高剂量美法仑（HDM）并获得干细胞支持。她在移植后迅速复发。Southern印迹和荧光原位杂交分析显示骨髓瘤细胞中存在MLL基因重排，而在诊断时的样本或用依托泊苷加G-CSF采集的外周血干细胞中未检测到。这些观察结果表明，MLL基因的克隆重排是由依托泊苷引起的。接受HDM及干细胞救援的MM患者不仅继发白血病的风险增加，骨髓瘤细胞中继发遗传异常的风险也可能增加，尤其是那些接受依托泊苷预处理以采集外周血干细胞的患者。
