Abstract
Extramedullary relapse of acute lymphoblastic leukemia (ALL) after allogeneic hematopoietic stem cell transplantation (HSCT) is infrequent. In general, the sites of extramedullary relapse are mainly the central nervous system (CNS) and testis, which are so called sanctuary sites. In sites of extramedullary relapse, renal or pancreatic involvements after HSCT are extremely rare in ALL. Here we described a case of 17 year-old male, who was diagnosed as ALL with the t(1;19)/TCF3-PBX1. At twenty months after the fourth myeloablative HSCT, he had extramedullay relapse, which concurrently occurred in pancreas and bilateral kidneys in spite of maintaining hematological complete remission in bone marrow (BM). He had never had extramedullary replaspe including in CNS and testis before this episode. Concurrent involvement of two solid organs (pancreas and kidney) after HSCT as in the present case has not been described.
Highlights
Extramedullary relapse of acute lymphoblastic leukemia (ALL) after allogeneic hematopoietic stem cell transplantation (HSCT) is infrequent with rates of extramedullary involvement reported in 11% [1]
The sites of extramedullary relapse are mainly the central nervous system (CNS) and testis, which are so called sanctuary sites, that are protected from systemic chemotherapy by biological blood barriers (CNS) or distinct growth condition [2]
A 17-year-old male was diagnosed with acute lymphoblastic leukemia (ALL; chimeric transcription factor 3 (TCF3)/pre-B cell leukemia homobox 1 (PBX1) fusion transcript+) in October, 2006
Summary
Extramedullary relapse of acute lymphoblastic leukemia (ALL) after allogeneic hematopoietic stem cell transplantation (HSCT) is infrequent with rates of extramedullary involvement reported in 11% [1]. In sites of extramedullary relapse, either renal involvement or pancreatic infiltration of leukemic cells after HSCT is very rare. An increased number of leukemic cells and chimeric TCF3/PBX1 fusion transcripts were detected in the BM 2 months later; the immunosuppressants (prednisolone; PSL and tacrolimus) were tapered rapidly and discontinued.
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