内容紹介
Sudden Blast Crisis of Chronic Myeloid Leukemia after a 13-Year Durable Remission Following Allogeneic Bone Marrow Transplantation and Donor Lymphocyte Infusion
Summary
We describe a rare case of sudden blast crisis of chronic myeloid leukemia that occurred after a 13-year durable remission, following allogeneic bone marrow transplantation and donor lymphocyte infusion. A 55-year-old Japanese man was diagnosed with chronic-phase chronic myeloid leukemia 24 years previously. He underwent allogeneic bone marrow transplantation 2 years after diagnosis. Although the disease recurred 6 years after transplantation, the patient achieved remission again by a donor lymphocyte infusion. Despite a 13-year durable remission, the disease later relapsed into a sudden blast crisis. Prednisolone and vincristine combined with imatinib mesylate effectively achieved a major molecular response. However, the disease relapsed repeatedly with central nervous system infiltration. Dasatinib and intrathecal methotrexate, cytarabine, and dexamethasone administration via the Ommaya reservoir controlled disease progression. Nevertheless, the disease became refractory to treatment with the emergence of a T315I Bcr-Abl gene mutation. The patient eventually died 43 months post-crisis.
要旨
症例は55歳,男性。24年前に慢性骨髄性白血病を発症し,22年前に実弟から同種骨髄移植を受けた。移植6年後再発しドナーリンパ球輸注療法で再寛解が得られ,以後13年間寛解であったがsudden blast crisisで再発した。メシル酸イマチニブ,ダサチニブにより,いったん分子遺伝学的効果が得られるも再発を繰り返し,Bcr-Abl遺伝子のT315I変異を来してsudden blast crisisから3年半後に死亡した。移植後長期寛解後に再発したこと,再発形式がsudden blast crisisであったことから,本例は非常にまれな症例と考えられた。
目次
Summary
We describe a rare case of sudden blast crisis of chronic myeloid leukemia that occurred after a 13-year durable remission, following allogeneic bone marrow transplantation and donor lymphocyte infusion. A 55-year-old Japanese man was diagnosed with chronic-phase chronic myeloid leukemia 24 years previously. He underwent allogeneic bone marrow transplantation 2 years after diagnosis. Although the disease recurred 6 years after transplantation, the patient achieved remission again by a donor lymphocyte infusion. Despite a 13-year durable remission, the disease later relapsed into a sudden blast crisis. Prednisolone and vincristine combined with imatinib mesylate effectively achieved a major molecular response. However, the disease relapsed repeatedly with central nervous system infiltration. Dasatinib and intrathecal methotrexate, cytarabine, and dexamethasone administration via the Ommaya reservoir controlled disease progression. Nevertheless, the disease became refractory to treatment with the emergence of a T315I Bcr-Abl gene mutation. The patient eventually died 43 months post-crisis.
要旨
症例は55歳,男性。24年前に慢性骨髄性白血病を発症し,22年前に実弟から同種骨髄移植を受けた。移植6年後再発しドナーリンパ球輸注療法で再寛解が得られ,以後13年間寛解であったがsudden blast crisisで再発した。メシル酸イマチニブ,ダサチニブにより,いったん分子遺伝学的効果が得られるも再発を繰り返し,Bcr-Abl遺伝子のT315I変異を来してsudden blast crisisから3年半後に死亡した。移植後長期寛解後に再発したこと,再発形式がsudden blast crisisであったことから,本例は非常にまれな症例と考えられた。