Clinical characteristics and outcome of isolated extramedullary relapse in acute leukemia after allogeneic stem cell transplantation: A single-center analysis
Clinical characteristics and outcome of isolated extramedullary relapse in acute leukemia after allogeneic stem cell transplantation: A single-center analysis
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急性白血病异基因干细胞移植后孤立性髓外复发的临床特征和结局：单中心分析
DOI：
10.1016/j.leukres.2012.12.002
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发表时间：
2013-04-01
影响因子：
2.7
通讯作者：
Huang, He
中科院分区：
文献类型：
--
作者：
Shi, Ji-Min;Meng, Xiao-Jian;Huang, He
急性白血病（AL）的孤立性髓外复发（EMR）是一种罕见的病例。然而，它似乎在同种异体干细胞移植（allo-SCT）后更常见。为了描述在分离EMR中观察到的情况，我们研究了287例接受同种异体细胞移植的AL患者（144例急性髓性白血病；138例急性淋巴细胞白血病；5例急性混合谱系白血病）。12例在髓外部位复发，未伴发骨髓（BM）。髓外部位的同种异体细胞移植后复发的时间长于骨髓（中位，10个月对5.5个月）。EMR部位变化很大，包括中枢神经系统、皮肤、骨骼、骨盆和乳房。单因素分析表明，细胞遗传学异常与分离EMR的发病显著相关（P=0.001）。发生EMR的患者预后仍然很差，但相对于BM复发后的患者要好（总生存期，10个月对18个月）。与局部或单一治疗相比，全身联合局部治疗可获得较好的预后。总之，我们观察到大量AL患者在同种异体sct后发生孤立性EMR，细胞遗传学异常与孤立性EMR的发生显著相关。我们发现，结合局部和全身治疗的强化方法可以产生良好的反应，可能治愈这些患者的一部分。(c) 2012 Elsevier Ltd.版权所有。
Isolated extramedullary relapse (EMR) of acute leukemia (AL) is a rare occurrence. However, it appears to be more common after allogeneic stem cell transplantation (allo-SCT). To characterize what has been observed in isolated EMR, we investigated 287 consecutive AL patients (144 acute myeloid leukemia; 138 acute lymphocytic leukemia; 5 acute mixed-lineage leukemia) who underwent allo-SCT. Twelve cases experienced relapse at extramedullary sites without concomitant involvement of the bone marrow (BM). The onset to relapse after allo-SCT was longer in extramedullary sites than in the BM (median, 10 months versus 5.5 months). EMR sites varied widely and included the central nervous system, skin, bone, pelvis and breasts. Univariate analysis demonstrated that cytogenetic abnormalities were correlated significantly with the onset of isolated EMR (P=0.001). The prognosis for patients who develop EMR remained poor but was relatively better than that after BM relapse (overall survival, 10 versus 18 months). Compared with local or single therapy, patients treated with systemic treatment in combination with local treatment could yield a favorable prognosis. In conclusion, we observed a significant number of isolated cases of EMR in AL patients after allo-SCT, cytogenetic abnormalities were correlated significantly with the onset of isolated EMR. We found that intensive approaches combining local and systemic therapy could produce favorable responses which may cure a proportion of these patients. (c) 2012 Elsevier Ltd. All rights reserved.