Koharazawa Hideyuki, Yamaji Satoshi, Takasaki Hirotaka, Takabayashi Maki, Fujimaki Katsumichi, Taguchi Jun, Kanamori Heiwa, Ishigatsubo Yoshiaki
Department Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine.
Rinsho Ketsueki. 2005 Jul;46(7):496-500.
A 31-year-old man was diagnosed as having cutaneous T-cell lymphoma in January 1994. He received an allogeneic bone marrow transplantation (BMT) from an HLA-matched sibling donor in May 1995, because of refractoriness to chemotherapy. The patient had been treated with immunosuppressants including prednisolone and cyclosporin A for chronic graft-versus-host disease (GVHD) of the extensive type following acute GVHD. Five years after the BMT, he developed moderately differentiated squamous cell carcinoma (SCC) on the mandibular gingival mucosa and underwent surgical resection. Furthermore, 6 years after the BMT well differentiated SCC developed on his palate and was resected. Concurrently, he was diagnosed as having esophageal cancer (poorly differentiated SCC) and underwent a subtotal esophagotomy. One year later he had a recurrence of the esophageal cancer with dysphagia and was treated with radiation and chemotherapy. He remains free of triple cancer and lymphoma. It is suggested that total body irradiation, immunosuppressants, and chronic GVHD are associated with a risk of secondary malignancies following allogeneic BMT. These factors might have contributed to the onset of triple cancer in our patient.
一名31岁男性于1994年1月被诊断为皮肤T细胞淋巴瘤。由于化疗耐药，他于1995年5月接受了来自HLA匹配同胞供者的异基因骨髓移植（BMT）。该患者因急性移植物抗宿主病（GVHD）后广泛型慢性GVHD接受了包括泼尼松龙和环孢素A在内的免疫抑制剂治疗。BMT后5年，他下颌牙龈黏膜出现中度分化鳞状细胞癌（SCC）并接受了手术切除。此外，BMT后6年，他腭部出现高分化SCC并被切除。同时，他被诊断为食管癌（低分化SCC）并接受了次全食管切除术。1年后，他因吞咽困难出现食管癌复发，接受了放疗和化疗。他目前无三重癌和淋巴瘤。提示全身照射、免疫抑制剂和慢性GVHD与异基因BMT后继发恶性肿瘤的风险相关。这些因素可能促成了我们这位患者三重癌的发生。
