Philadelphia chromosome-positive acute lymphoblastic leukemia complicated by bone marrow necrosis during consolidation chemotherapy
Philadelphia chromosome-positive acute lymphoblastic leukemia complicated by bone marrow necrosis during consolidation chemotherapy
复制标题
费城染色体阳性急性淋巴细胞白血病巩固化疗并发骨髓坏死
DOI：
10.11406/rinketsu.61.462
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
栗田 尚樹
中科院分区：
文献类型：
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作者：
石塚 幹太郎;錦井 秀和;横山 泰久;坂田（柳元） 麻実子;長谷川 雄一;品川 篤司;千葉 滋;小原 直;周山 拓也;松岡 亮太;丸山 ゆみ子;坂本 竜弘;日下部 学;加藤 貴康;栗田 尚樹
一名46岁的男子谁曾接受过开放手术的肾细胞癌（RCC）发展费城染色体阳性急性淋巴细胞白血病（Ph-ALL）。经过诱导治疗后，他获得了完全的分子缓解。然而，在巩固治疗期间，发热和双侧坐骨神经痛持续存在。18 F-氟脱氧葡萄糖（FDG）正电子发射断层扫描-计算机断层扫描（PET-CT）显示髂骨和骶骨中FDG蓄积;但是，未检测到致病性疾病，包括Ph-ALL和RCC复发。髂骨髓活检显示骨髓坏死（BMN），其病因被推测为白血病本身和化疗的治疗反应。在接下来的几个月内观察到发热消退和疼痛缓解。我们观察到在骨髓中弥漫性纤维化在脐带血移植后第162天和第364天。此外，PET-CT上的FDG蓄积显著减少。尽管BMN与血液系统恶性肿瘤有潜在的相关性，但它并没有得到广泛的认可。应审查其他BMN病例，以阐明BMN病因和临床特征。
A 46-year-old man who had previously undergone open surgery for renal cell carcinoma (RCC) developed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-ALL). After the induction therapy, he achieved complete molecular remission. However, fever and bilateral buttock pain continued during the consolidation therapy. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) showed FDG accumulation in both iliac bones and in the sacrum; however, no causative diseases, including relapse of Ph-ALL and RCC, were detected. Iliac bone marrow biopsy revealed bone marrow necrosis (BMN), the etiology of which was presumed to be the leukemia itself and the therapeutic response to chemotherapy. Fever resolution and buttock pain alleviation were observed over the next months. We observed diffuse fibrosis in the bone marrow at day 162 and day 364 after cord blood transplantation. Moreover, the FDG accumulation was significantly reduced on PET-CT. BMN is not widely recognized despite its potential association with hematologic malignancies. Additional cases of BMN should be reviewed to clarify BMN etiology and clinical features.