Cunningham Isabel
Jacobi Medical Center, Bronx, NY 10032, USA.
Leuk Lymphoma. 2006 Sep;47(9):1754-67. doi: 10.1080/10428190600632857.
Recurrent or residual leukemia found in extramedullary sites after intensive treatments adversely affects prognosis. To summarize the sites and outcomes when extramedullary relapses have been reported after stem cell transplants, and to elucidate when long survival has been achieved, 207 cases were analysed. Authors were contacted for follow-up information. The most commonly reported sites are soft tissue in acute leukemias and bone in CML. Extramedullary relapse occurred typically within 2 years in ALL, but later in one-third of myeloid leukemias. Most testicular relapses reported in AML followed non-TBI conditioning. Marrow relapse was not inevitable if aggressive treatment was begun early. Local therapy alone was generally inadequate. Intensive therapy has produced lengthy remissions in cases of acute leukemias involving various sites, whereas CML cases, particularly involving bone, were most resistant to treatment. Heightened awareness and aggressive treatment should improve the prospect for cure after extramedullary relapse.
强化治疗后在髓外部位发现的复发性或残留性白血病会对预后产生不利影响。为总结干细胞移植后报告有髓外复发时的复发部位及预后情况，并阐明何时能实现长期生存，对207例病例进行了分析。已与作者联系以获取随访信息。最常报告的复发部位在急性白血病中是软组织，在慢性粒细胞白血病中是骨骼。急性淋巴细胞白血病的髓外复发通常发生在2年内，但三分之一的髓系白血病复发较晚。急性髓系白血病中报告的大多数睾丸复发发生在非全身照射预处理之后。如果早期开始积极治疗，骨髓复发并非不可避免。单独的局部治疗通常是不够的。强化治疗已使累及不同部位的急性白血病病例获得了较长时间的缓解，而慢性粒细胞白血病病例，尤其是累及骨骼的病例，对治疗最具抗性。提高认识并积极治疗应能改善髓外复发后的治愈前景。
