Golembe B, Ramsay N K, McKenna R, Nesbit M E, Krivit W
Med Pediatr Oncol. 1979;6(3):229-34. doi: 10.1002/mpo.2950060307.
Localized bone marrow relapse is rare in acute lymphoblastic leukemia. Discordant bone marrow specimens were found in an 11-year-old asymptomatic girl who had been in remission for six years and off chemotherapy for 2 1/2 years. One bone marrow sample showed marked leukemic infiltration, whereas marrow from another site was normal. Three months later, with normal peripheral blood counts, she developed severe back pain and x-ray evidence of vertebral collapse and periosteal changes in the pubic bone. At that time three of the four areas of bone marrow sampled showed leukemic involvement. Reinduction therapy was begun, and she is now in remission on maintenance chemotherapy. At this time, it is unclear whether routine performance of marrow aspirations and biopsies from multiple sites, in periodic follow-up examinations of patients with acute leukemia would allow earlier detection of relapse frequently enough to justify the procedure. The issue of localized bone marrow involvement, if more common than previously reported, should be addressed at the time a decision is being made to discontinue therapy.
急性淋巴细胞白血病局部骨髓复发较为罕见。在一名11岁无症状女孩身上发现了不一致的骨髓标本，该女孩已缓解六年，停止化疗2年半。一份骨髓样本显示有明显的白血病浸润，而另一个部位的骨髓则正常。三个月后，外周血细胞计数正常，但她出现了严重的背痛，X线显示椎体塌陷以及耻骨骨膜改变。此时，所采集骨髓的四个部位中有三个显示有白血病累及。于是开始再次诱导治疗，她现在在维持化疗下处于缓解状态。目前尚不清楚，在急性白血病患者的定期随访检查中，常规从多个部位进行骨髓穿刺和活检是否能足够频繁地早期发现复发，从而证明该操作的合理性。如果局部骨髓受累比之前报道的更为常见，那么在决定停止治疗时就应予以考虑。
