Sharp Hadley, Grosshans David, Kadia Tapan, Dabaja Bouthaina Shbib
Radiation Oncology, UT MD Anderson Cancer Center, Houston, Texas, USA.
BMJ Case Rep. 2012 Jul 11;2012:bcr0220125742. doi: 10.1136/bcr.02.2012.5742.
Treatment of recurrent acute lymphoblastic leukaemia (ALL) often involves allogeneic stem-cell transplantation (alloSCT) and disease recurrence in the central nervous system may require craniospinal irradiation. Although graft-versus-host disease (GVHD) is a known risk after alloSCT, cutaneous manifestation within radiation fields is rarely seen. The authors report a case of a 25-year-old man with Philadelphia+ALL recurring in the central nervous system after a homologous SCT. Craniospinal radiation was delivered with proton therapy to a total dose of 24 cobalt-Gray-equivalents in 12 fractions. Eight weeks after the proton therapy, significant cutaneous GVHD had developed within the radiation fields. This was treated successfully with tacrolimus (4 mg/day), a short course of methylprednisolone, and topical treatment with 0.1% triamcinolone cream, 0.05% clobetasol ointment. Cutaneous GVHD after SCT can be seen within proton radiation fields probably due to an inherent higher skin dose.
复发性急性淋巴细胞白血病（ALL）的治疗通常涉及异基因干细胞移植（alloSCT），而中枢神经系统疾病复发可能需要进行全脑脊髓照射。虽然移植物抗宿主病（GVHD）是alloSCT后已知的风险，但辐射野内的皮肤表现很少见。作者报告了一例25岁男性，在同源干细胞移植后中枢神经系统复发费城阳性ALL。采用质子治疗进行全脑脊髓照射，总剂量为24钴-戈瑞当量，分12次给予。质子治疗8周后，辐射野内出现了明显的皮肤GVHD。使用他克莫司（4毫克/天）、短期甲泼尼龙疗程以及外用0.1%曲安奈德乳膏、0.05%氯倍他索软膏成功治疗。SCT后的皮肤GVHD可能由于质子辐射野内固有较高的皮肤剂量而出现。
