Hoshino Takumi, Hatsumi Nahoko, Iino Hiromasa, Takada Satoru
Leukemia Research Center, Saiseikai Maebashi Hospital, Kamishinden-machi, 564-1, Maebashi, Gunma, 371-0821, Japan.
Int J Hematol. 2022 Dec;116(6):902-910. doi: 10.1007/s12185-022-03442-5. Epub 2022 Aug 28.
Some allogeneic stem cell transplantation (allo-SCT) recipients develop therapy-related myeloid neoplasms (t-MNs) of recipient origin with features including karyotypically abnormal hematopoiesis without cell dysplasia and myeloblast increase. However, due to their rarity their clinical course remains unclear. We report six cases of t-MN in patients with chromosomal abnormalities (CAs) after autologous recovery following allo-SCT for acute leukemia. CAs were first detected at a median interval of 422 (range 30-1941) days from allo-SCT. The fraction of CA-bearing cells of recipient origin increased with time, and cytogenetic relapse of underlying disease was not observed. Continuous emergence of identical autologous CAs was observed in one patient who did not receive total body irradiation (TBI). The other five patients received TBI, and complex karyotypes with the appearance of different types of CAs were the most dominant feature. Despite the persistence of complex abnormalities in the irradiated patients, no patient developed therapy-related acute myeloid leukemia (t-AML). TBI appears to be the major cause of t-MN of recipient origin with different types of CAs. Although t-MNs in patients receiving TBI do not initially seem to evolve to overt t-AML, they were associated with higher risk of underlying disease and greater oncogenic potential of irradiation.
一些异基因干细胞移植（allo-SCT）受者会发生源自受者的治疗相关髓系肿瘤（t-MNs），其特征包括核型异常造血但无细胞发育异常以及原始粒细胞增多。然而，由于其罕见性，它们的临床病程仍不清楚。我们报告了6例急性白血病患者在allo-SCT自体恢复后出现染色体异常（CAs）的t-MN病例。CAs首次检测到的时间距allo-SCT的中位间隔为422天（范围30 - 1941天）。源自受者的携带CA的细胞比例随时间增加，且未观察到基础疾病的细胞遗传学复发。在未接受全身照射（TBI）的1例患者中观察到相同的自体CAs持续出现。其他5例患者接受了TBI，具有不同类型CAs出现的复杂核型是最主要的特征。尽管接受照射的患者中复杂异常持续存在，但没有患者发生治疗相关急性髓系白血病（t-AML）。TBI似乎是具有不同类型CAs的源自受者的t-MN的主要原因。虽然接受TBI的患者中的t-MNs最初似乎不会演变为明显的t-AML，但它们与基础疾病的较高风险以及照射的更大致癌潜力相关。
