Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, 55455, USA.
Biol Blood Marrow Transplant. 2012 Jan;18(1):106-12. doi: 10.1016/j.bbmt.2011.05.023. Epub 2011 Jun 12.
Allogeneic hematopoietic cell transplantation (HSCT) is considered a curative treatment for acute myelogenous leukemia (AML). Extramedullary relapse after HSCT for AML is a rare event and is less well defined than systemic, hematologic relapse. We retrospectively studied all patients with AML (n = 436) who underwent HSCT at the University of Minnesota between 1996 and 2008 who developed either a bone marrow (BM) or extramedullary (EM) relapse, and examined the incidence and risk factors for BM and EM relapse. Of 128 patients who relapsed post-HSCT, 25 had relapse in EM sites, either isolated (n = 13) or with concurrent BM relapse (n = 12). Relapse sites included bone (n = 1), central nervous system (n = 6), gastrointestinal (n = 4), lymphatic (n = 4), skin (n = 5), genitourinary (n = 1), pulmonary (n = 1), and soft tissue (n = 3). The time to relapse was longer in the EM sites (median, 328 days vs 168 days). Patients with EM relapse were more likely to have had preceding acute graft-versus-host disease (GVHD) (77% vs 49%; P = .03) or chronic GVHD (46% vs 15%; P = .02) compared with those with BM relapse. The 6-month survival postrelapse was significantly better in patients with isolated EM relapse (69%) compared with those with combined EM and BM relapse (8%) or those with BM relapse alone (27%) (P < .01). Compared with local therapy alone, systemic therapy yielded better 6-month survival in patients with EM relapse. This study suggests differing pathogenesis of BM relapse versus EM relapse of AML after allogeneic HSCT. GVHD and its accompanying graft-versus-leukemia effect may better protect BM sites, but patients with EM relapse have better responses to combined therapy and improved survival compared with those with BM relapse.
异基因造血细胞移植（HSCT）被认为是急性髓系白血病（AML）的一种根治性治疗方法。AML 患者 HSCT 后发生髓外复发是一种罕见事件，且不如血液系统复发那样明确。我们回顾性研究了 1996 年至 2008 年在明尼苏达大学接受 HSCT 且发生骨髓（BM）或髓外（EM）复发的 436 例 AML 患者，检查了 BM 和 EM 复发的发生率和危险因素。在 128 例 HSCT 后复发的患者中，25 例有 EM 部位的复发，包括孤立性（n = 13）或同时伴有 BM 复发（n = 12）。复发部位包括骨骼（n = 1）、中枢神经系统（n = 6）、胃肠道（n = 4）、淋巴系统（n = 4）、皮肤（n = 5）、泌尿生殖系统（n = 1）、肺部（n = 1）和软组织（n = 3）。EM 部位的复发时间更长（中位数，328 天 vs 168 天）。与 BM 复发的患者相比，EM 复发的患者更可能有先前的急性移植物抗宿主病（GVHD）（77% vs 49%；P =.03）或慢性 GVHD（46% vs 15%；P =.02）。与同时发生 EM 和 BM 复发或仅发生 BM 复发的患者相比，孤立性 EM 复发的患者在复发后 6 个月的生存率明显更高（69% vs 8%或 27%）（P <.01）。与单独局部治疗相比，系统性治疗在 EM 复发患者中产生了更好的 6 个月生存率。本研究表明，异基因 HSCT 后 AML 的 BM 复发与 EM 复发具有不同的发病机制。GVHD 及其伴随的移植物抗白血病效应可能更好地保护 BM 部位，但与 BM 复发患者相比，EM 复发患者对联合治疗有更好的反应，生存率更高。
