Imanaka Ryouta, Katayama Yuta, Iwato Koji, Kyo Kouhei, Okatani Takeshi, Itagaki Mitsuhiro, Katsutani Shinya, Asaoku Hideki
Division of Hematology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital.
Division of Transfusion, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital.
Rinsho Ketsueki. 2018;59(1):58-63. doi: 10.11406/rinketsu.59.58.
The poor prognosis of extramedullary recurrence of acute leukemia following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a therapeutic challenge, and thus far no effective treatment method has been established. Here, we report two patients who presented with relapsed leukemia as extramedullary tumor in the ovary following allo-HSCT. Case 1: A 23-year-old female underwent unrelated allogeneic bone marrow transplantation during the second remission of acute myeloid leukemia. After 706 days post-transplant, bilateral ovarian tumors were detected during the pelvic ultrasound, and extramedullary recurrence in the bilateral ovaries was subsequently established on right salpingo-oophorectomy and biopsy of the left ovary. Following completed systemic chemotherapy and total body irradiation, the patient underwent unrelated cord blood transplantation (CBT) and remission was maintained without recurrence for 7 years after second transplantation. Case 2: A 49-year-old female underwent unrelated CBT during the second remission of acute lymphocytic leukemia. At 372 days post-transplant, a pelvic tumor was detected by FDG-PET/CT, and extramedullary recurrence in the right ovary was diagnosed on examination of the resected pelvic mass. Chemotherapy and radiation were performed, but the tumor recurred on day 1,027 and the patient died on day 1,603. Extramedullary recurrence of adult acute leukemia as a mass in the ovary following allo-HSCT has been rarely reported. Therefore, further accumulation of related case reports is desired.
异基因造血干细胞移植（allo-HSCT）后急性白血病髓外复发的预后较差，仍然是一个治疗挑战，迄今为止尚未建立有效的治疗方法。在此，我们报告两例患者，他们在allo-HSCT后出现白血病复发，表现为卵巢髓外肿瘤。病例1：一名23岁女性在急性髓系白血病第二次缓解期接受了无关供者异基因骨髓移植。移植后706天，盆腔超声检查发现双侧卵巢肿瘤，随后通过右侧输卵管卵巢切除术和左侧卵巢活检确诊为双侧卵巢髓外复发。在完成全身化疗和全身照射后，患者接受了无关供者脐血移植（CBT），第二次移植后缓解维持了7年无复发。病例2：一名49岁女性在急性淋巴细胞白血病第二次缓解期接受了无关供者CBT。移植后372天，通过FDG-PET/CT检测到盆腔肿瘤，经切除的盆腔肿块检查确诊为右侧卵巢髓外复发。进行了化疗和放疗，但肿瘤在第1027天复发，患者于第1603天死亡。allo-HSCT后成人急性白血病作为卵巢肿块的髓外复发很少有报道。因此，需要进一步积累相关病例报告。
