Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Science, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Int J Hematol. 2023 Feb;117(2):287-292. doi: 10.1007/s12185-022-03458-x. Epub 2022 Sep 22.
Donor-derived hematological malignancies have been recognized as rare but serious late complications in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Most cases in the literature were diagnosed as myelodysplastic syndrome or acute leukemia, with very few malignant lymphoma reported. We herein present another case of donor-derived Burkitt lymphoma that occurred 9 years after allo-HSCT under continued administration of immunosuppressants for chronic graft-versus-host disease (GVHD). The patient achieved a partial response after rituximab-combined intensive chemotherapy. To reduce the risk of relapse and to avoid organ toxicities due to repeated chemotherapies, we performed upfront high-dose chemotherapy followed by stem cell rescue using donor-derived CD34 cells, called pseudo-autologous HSCT (pASCT), and adjusted immunosuppressants appropriately. The patient remained disease-free for 23 months after pASCT without exacerbation of cGVHD. Although the observation period has been relatively short and longer follow-up is needed, pASCT may be a feasible option for donor-derived lymphoma even in patients with active cGVHD.
供者源性血液系统恶性肿瘤已被认为是异基因造血干细胞移植（allo-HSCT）受者罕见但严重的晚期并发症。文献中的大多数病例被诊断为骨髓增生异常综合征或急性白血病，很少有恶性淋巴瘤报道。我们在此报告另 1 例 allo-HSCT 后 9 年在持续免疫抑制治疗慢性移植物抗宿主病（GVHD）的情况下发生的供者源性伯基特淋巴瘤。在利妥昔单抗联合强化化疗后，患者达到部分缓解。为了降低复发风险并避免因反复化疗导致的器官毒性，我们进行了预先高剂量化疗，然后使用供者源性 CD34 细胞进行干细胞挽救，称为伪自体 HSCT（pASCT），并适当调整免疫抑制剂。pASCT 后，患者在无 cGVHD 恶化的情况下无病生存 23 个月。尽管观察期相对较短，需要更长时间的随访，但即使在活动性 cGVHD 患者中，pASCT 也可能是供者源性淋巴瘤的一种可行选择。
