Successful treatment with allogeneic stem cell transplantation followed by DLI and TKIs for e6a2 BCR-ABL-positive acute myeloid leukaemia
Successful treatment with allogeneic stem cell transplantation followed by DLI and TKIs for e6a2 BCR-ABL-positive acute myeloid leukaemia
复制标题
同种异体干细胞移植后联合 DLI 和 TKI 成功治疗 e6a2 BCR-ABL 阳性急性髓系白血病
作者：
Y. Harada;S. Nishiwaki;T. Sugimoto;Koichi Onodera;T. Goto;Takahiko Sato;S. Kamoshita;N. Kawashima;A. Seto;S. Okuno;Satomi Yamamoto;Toshihiro Iwasaki;Y. Ozawa;K. Miyamura;Y. Akatsuka;I. Sugiura
理由：e6a2 BCR-ABL转录本（非典型转录本中的一种）患者预后较差，异体干细胞移植（ASCT）可以考虑作为附加治疗。然而，ASCT后的长期存活是罕见的。患者关注：本报告涉及一名55岁女性e6a2 bcr - abl阳性急性髓性白血病患者，包括ASCT后供体淋巴细胞输注（DLI）的结果。诊断：断点经直接测序确认。她的微小残留疾病可以通过巢式逆转录聚合酶链反应检测到，使用引物用于次要BCR-ABL （e1a2）转录物。干预措施：酪氨酸激酶抑制剂（TKIs）和ASCT治疗，然后是DLI。结果：尽管ASCT后多次细胞遗传学和分子复发，但患者在ASCT后46个月仍处于分子缓解期。结论：本病例提示移植物抗白血病效应与TKIs联合治疗e6a2 bcr - abl阳性急性白血病的疗效。当发现费城染色体有异常的染色体断点时，我们应该明确断点，因为这些信息可以帮助分子评估和决定提供额外或替代治疗。
Rationale: Patients with the e6a2 BCR-ABL transcript, 1 of the atypical transcripts, have been reported to have a poor prognosis, and allogeneic stem cell transplantation (ASCT) can be considered as additional therapy. However, long-term survival after ASCT for this disease is rare. Patient concerns: This report concerns a 55-year-old female patient with e6a2 BCR-ABL-positive acute myeloid leukemia including the outcome of ASCT followed by donor lymphocyte infusion (DLI). Diagnoses: The breakpoint was confirmed by direct sequencing. Her minimal residual disease could be detected by nested reverse-transcription polymerase chain reaction using primers for the minor BCR-ABL (e1a2) transcript. Interventions: Treatment with tyrosine kinase inhibitors (TKIs) and ASCT followed by DLI. Outcomes: Despite multiple cytogenetic and molecular relapses after ASCT, she remains in molecular remission at 46 months after ASCT. Lessons: This case indicates the efficacy of the combination of the graft-versus-leukemia effect and TKIs for e6a2 BCR-ABL-positive acute leukemia. When the Philadelphia chromosome with an unusual chromosomal breakpoint is suggested, we should clarify the breakpoint because that information can aid molecular assessments and decisions to provide an additional or alternative therapy.
DOI：
10.1016/j.bbmt.2014.12.001
发表时间：
2015-03
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
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作者：
Jagasia MH;Greinix HT;Arora M;Williams KM;Wolff D;Cowen EW;Palmer J;Weisdorf D;Treister NS;Cheng GS;Kerr H;Stratton P;Duarte RF;McDonald GB;Inamoto Y;Vigorito A;Arai S;Datiles MB;Jacobsohn D;Heller T;Kitko CL;Mitchell SA;Martin PJ;Shulman H;Wu RS;Cutler CS;Vogelsang GB;Lee SJ;Pavletic SZ;Flowers ME
通讯作者：
Flowers ME