Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Bone Marrow Transplant. 2012 May;47(5):669-76. doi: 10.1038/bmt.2011.163. Epub 2011 Aug 22.
Extramedullary (EM) relapse of leukemia after allo-SCT in patients with AML/myelodysplastic syndrome has been increasingly reported. The reduced effectiveness of the GVL effect in EM sites, as compared with BM, has been suggested to underlie this problem. We retrospectively analyzed the pattern of relapse after haploidentical SCT (haplo-SCT), performed as the first or second SCT. Among 38 patients who received haplo-SCT as their first SCT, the cumulative incidences of BM and EM relapse at 3 years were 40.5 and 10.9%, respectively. Among 19 patients who received haplo-SCT as their second SCT, the cumulative incidences of BM and EM relapse were 30.9 and 31.9%, respectively. Moreover, most of the patients who underwent repeat haplo-SCT for the treatment of EM relapse had further EM relapse at other sites. Post-relapse survival did not differ significantly with different patterns of relapse. The frequent occurrence of EM relapse after haplo-SCT, particularly when performed as a second SCT, suggests that the potent GVL effect elicited by an HLA disparity also occurs preferentially in BM. Our findings emphasize the need for a treatment strategy for EM relapse that recognizes the reduced susceptibility of EM relapse to the GVL effect.
在接受异体造血干细胞移植（allo-SCT）后，急性髓系白血病/骨髓增生异常综合征（AML/MDS）患者发生髓外（EM）白血病复发的情况越来越多。相较于骨髓（BM），EM 部位的移植物抗白血病（GVL）效应效力降低，这被认为是导致该问题的原因。我们回顾性分析了半相合造血干细胞移植（haplo-SCT）作为首次或二次 SCT 后的复发模式。在 38 例接受 haplo-SCT 作为首次 SCT 的患者中，3 年时 BM 和 EM 复发的累积发生率分别为 40.5%和 10.9%。在 19 例接受 haplo-SCT 作为二次 SCT 的患者中，BM 和 EM 复发的累积发生率分别为 30.9%和 31.9%。此外，大多数因 EM 复发而行重复 haplo-SCT 治疗的患者在其他部位出现进一步的 EM 复发。复发后的生存与不同的复发模式无显著差异。haplo-SCT 后 EM 复发频繁，尤其是作为二次 SCT 时，这表明 HLA 差异引起的强大 GVL 效应也优先发生在 BM 中。我们的研究结果强调，需要针对 EM 复发制定一种治疗策略，该策略应认识到 EM 复发对 GVL 效应的敏感性降低。
