Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, 755-8505, Japan.
Internal Medicine, Ogoori Daiichi Hospital, Yamaguchi, Japan.
Int J Hematol. 2009 Oct;90(3):374-377. doi: 10.1007/s12185-009-0385-3. Epub 2009 Jul 24.
Isolated extramedullary (EM) relapse of acute myelogenous leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. Predisposing factors include CD56 expression and the chromosomal abnormality t(8;21). We describe an AML patient showing the chromosomal abnormality t(8;21) and CD56 expression who experienced a unique EM relapse after allo-HSCT. Approximately 10 months after allo-HSCT, he experienced relapse involving the femur and lumbar vertebrae and, subsequently, an EM relapse of the stomach. Although we administered only local radiotherapy and not systemic chemotherapy, he showed no bone marrow relapse on long-term follow-up after achieving complete hematological remission. These findings suggest that the graft-versus-leukemia effect may preferentially maintain marrow remission rather than prevent EM relapse. In addition, our findings show that extended survival is possible after EM relapse following allo-HSCT in patients with marrow hematopoiesis of donor origin, and that augmentation of the graft-versus-leukemia effect may be useful.
异基因造血干细胞移植（allo-HSCT）后孤立性髓外（EM）复发的急性髓系白血病（AML）较为罕见。易患因素包括 CD56 表达和染色体异常 t（8；21）。我们描述了 1 例 AML 患者，其表现出染色体异常 t（8；21）和 CD56 表达，并在 allo-HSCT 后经历了独特的 EM 复发。allo-HSCT 后约 10 个月，他出现了累及股骨和腰椎的复发，并随后出现了胃的 EM 复发。尽管我们仅给予局部放疗而未给予全身化疗，但在获得完全血液学缓解后长期随访中他并未出现骨髓复发。这些发现表明移植物抗白血病效应可能优先维持骨髓缓解，而不是预防 EM 复发。此外，我们的研究结果表明，在供体骨髓造血的患者中，allo-HSCT 后发生 EM 复发仍可获得长期生存，并且增强移植物抗白血病效应可能是有用的。
