Skip to main content
SpringerLink
Log in

Extramedullary Leukemic Relapses Following Hematopoietic Stem Cell Transplantation with Nonmyeloablative Conditioning

  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Of a group of 149 patients who underwent allogeneic stem cell transplantation using the “Mexican approach,” a nonablative preparative regimen, 49 individuals developed bone marrow relapse, and 8 patients developed extramedullary relapse (EMR). All EMR cases presented in patients who received allografts for myeloid malignancies. In contrast, bone marrow relapses presented in patients with myeloid or lymphoid malignancies. EMR presented 60 to 1010 days after the allograft and appeared in 3 cases as subcutaneous nodules in different parts of the body, in the vertebrae in 3 cases, and in the kidney and the breast in 1 case each. One patient had both subcutaneous nodules and epididymis EMR. When EMR was noted, acute graft-versus-host disease (GVHD) had presented in 4 patients, and limited forms of chronic GVHD were present in 3 patients. All but 1 of the patients were full chimeras when the EMR ensued, and the EMR preceded an overt hematologic relapse in all but 1 of the patients. Patients who experienced an overt hematologic relapse died 20 to 180 days (median, 40 days) after the EMR. The only individual alive 240 days after relapse shows no evidence of a full-blown hematologic relapse. An EMR after allogeneic hematopoietic stem cell transplantation usually has a bad prognosis and presents mainly in individuals with high-risk malignancies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tsimberidou AM, Stavroyianni N, Viniou N, and the Hellenic Cooperative Group. Comparison of allogeneic stem cell transplantation, high-dose cytarabine, and autologous peripheral stem cell transplantation as postremission treatment in patients with de novo acute myelogenous leukemia. Cancer. 2003;97:1721–1731.

    Article  CAS  Google Scholar 

  2. Georges G, Storb R. Review of “minitransplantation”: nonmye-loablative allogeneic hematopoietic stem cell transplantation. Int J Hematol. 2003;77:3–14.

    Article  Google Scholar 

  3. Djulbegovic B, Seidenfeld J, Bonnell C, Kumar A. Nonmyeloabla-tive allogeneic stem-cell transplantation for hematologic malignancies: a systematic review. Cancer Control. 2003;10:17–31.

    Article  Google Scholar 

  4. Slavin S, Nagler A, Naparstek E, et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematological diseases. Blood. 1998;91:756–763.

    Article  CAS  Google Scholar 

  5. Giralt S, Estey E, Albitar M, et al. Engraftment of allogeneic hematopoietic progenitor cells with purine analog-containing chemotherapy: harnessing graft-versus-leukemia without myeloab-lative therapy. Blood. 1997;89:4531–4536.

    Article  CAS  Google Scholar 

  6. Ruiz-Argüelles GJ, Gómez-Almaguer D, Ruiz-Argüelles A, González-Llano O, Cantá OG, Jaime-Pérez JC. Results of an outpatient-based stem cell allotransplant program using non-mye-loablative conditioning regimens. Am J Hematol. 2001;66:241–244.

    Article  Google Scholar 

  7. Ruiz-Argüelles GJ, Gómez-Almaguer D, López-Martínez B, Cantú-Rodríguez OG, Jaime-Pérez JC, González-Llano O. Results of an allogeneic non-myeloablative stem cell transplantation program in patients with chronic myelogenous leukemia. Haematologica. 2002;87:894–896.

    PubMed  Google Scholar 

  8. Or R, Shapira MY, Resnick I, et al. Nonmyeloablative allogeneic stem cell transplantation for the treatment of chronic myeloid leukemia in first chronic phase. Blood. 2003:101:441–445.

    Article  CAS  Google Scholar 

  9. Martino R, Giralt S, Caballero MD, et al. Allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning in acute lymphoblastic leukemia: a feasibility study. Haematologica. 2003;88:555–560.

    PubMed  Google Scholar 

  10. Carella AM, Beltrami G, Carella M Jr, Corsetti MT, Scalzulli RP, Greco M. Immunosuppressive non-myeloablative allografting as salvage therapy in advanced Hodgkin’s disease. Haematologica. 2001;86:1121–1123.

    PubMed  CAS  Google Scholar 

  11. Ruiz-Argüelles GJ, Gómez-Almaguer D, Gómez Rangel JD, et al. Allogeneic hematopoietic stem cell transplantation with non-myeloablative conditioning in patients with acute leukemia eligible for conventional allografting: a prospective study. Leuk Lymphoma. 2004;45:1191–1195.

    Article  Google Scholar 

  12. Au WY, Kwong YL, Lie AK, Ma SK, Liang R. Extra-medullary relapse of leukemia following allogeneic bone marrow transplantation. Hematol Oncol. 1999;17:45–52.

    Article  CAS  Google Scholar 

  13. Lee KH, Lee JH, Choi SJ, et al. Bone marrow vs extramedullary relapse of acute leukemia after allogeneic hematopoietic cell transplantation: risk factors and clinical course. Bone Marrow Transplant. 2003;32:835–842.

    Article  CAS  Google Scholar 

  14. Lee KH, Lee JH, Kim S, Lee JS, Kim SH, Kim WK. High frequency of extramedullary relapse of acute leukemia after allogeneic bone marrow transplantation. Bone Marrow Transplant. 2000;26:147–152.

    Article  CAS  Google Scholar 

  15. Schafer H, Bader P, Kaiserling E, Klingebiel T, Handgretinger R, Einsele H. Extramedullary relapses at uncommon sites after allogeneic stem cell transplantation. Bone Marrow Transplant. 2000;26:1133–1135.

    Article  CAS  Google Scholar 

  16. Linn YC, Goh YT, Tan HC. Relapse of leukemia and lymphoma after marrow transplantation: review of cases with extramedullary relapse. Leuk Lymphoma. 2000;38:137–146.

    Article  CAS  Google Scholar 

  17. Au WY, Chan AC, Lie AK, Chen FE, Liang R, Kwong YL. Recurrent isolated extramedullary relapses as granulocytic sarcomas following allogeneic bone marrow transplantation for acute leukemia. Bone Marrow Transplant. 1998;21:205–208.

    Article  CAS  Google Scholar 

  18. Kessinger A, Armitage JO, Landmark JD, Smith DM, Weisen-burger DD. Autologous peripheral hematopoietic stem cell transplantation restores hemopoietic function following marrow ablative therapy. Blood. 1998;71:723–727.

    Article  Google Scholar 

  19. Ruiz-Argüelles A. Flow cytometry in the clinical laboratory: principles, applications and problems. Ann Biol Clin. 1992;50:735–743.

    Google Scholar 

  20. Ruiz-Argüelles A, Orfao A. Caracterización y evaluación de célu-las totipotenciales en sangre periférica y médula ósea. In: Ruiz-Argüelles GJ, San-Miguel JF, eds. Actualización en Leucemias México City, Mexico: Editorial Médica Panamericana; 1996:79–82.

    Google Scholar 

  21. Ruiz-Argüelles GJ, López-Martínez B, Santellán-Olea MR, et al. Follow up of hemopoietic chimerism in individuals given allogeneic hemopoietic stem cell allografts using an immunosuppressive, non-myeloablative conditioning regimen: a prospective study in a single institution. Leuk Lymphoma. 2002;43:1509–1511.

    Article  Google Scholar 

  22. Pinkel D, Straume T, Gray JW. Cytogenetic analysis using quantitative, high sensitivity, fluorescence hybridization. Proc Natl Acad Sci U S A. 1986;83:2934–2938.

    Article  CAS  Google Scholar 

  23. Yam P, Petz L, Knowlton R, et al. Use of DNA restriction fragment length polymorphisms to document marrow engraftment and mixed hematopoietic chimerism following bone marrow transplantation. Transplantation. 1987;43:399–407.

    Article  CAS  Google Scholar 

  24. Ruiz-Argüelles GJ, Garcés-Eisele J, Reyes-Núñez V, et al. Assessment of residual disease in acute leukemia by means of polymerase chain reaction. Rev Invest Clin. 2000;52:118–124.

    PubMed  Google Scholar 

  25. Ruiz-Argüelles GJ, Gómez-Almaguer D. Breaking dogmata to help patients: non-myeloablative haematopoietic stem cell transplantation. Expert Opin Biol Ther. 2004;4:1693–1699.

    Article  Google Scholar 

  26. Levine JE, Braun T, Penza SL, et al. Prospective trial of chemotherapy and donor leukocyte infusions for relapse of advanced myeloid malignancies after allogeneic stem-cell transplantation. J Clin Oncol. 2002;20:405–412.

    Article  CAS  Google Scholar 

  27. Choi SJ, Lee JH, Lee JH, et al. Treatment of relapsed acute myeloid leukemia after allogeneic bone marrow transplantation with chemotherapy followed by G-CSF-primed donor leukocyte infusion: a high incidence of isolated extramedullary relapse. Leukemia. 2004;18:1789–1797.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centro de Hematología y Medicina Interna de Puebla, 8B Sur 3710, 72530, Puebla, PUE, Mexico

    Guillermo J. Ruiz-Argüelles, Amelia Morales-Toquero & José David-Gómez-Rangel

  2. Laboratorios Clínicos de Puebla, Puebla, Mexico

    Guillermo J. Ruiz-Argüelles & Briceida López-Martínez

  3. Hospital Universitario de Monterrey, Universidad Autónoma de Nuevo León, Monterrey, Mexico

    David Gómez-Almaguer, Olga G. Cantú-Rodríguez & César H. Gutiérrez-Aguirre

  4. Centro Médico la Raza, Instituto Mexicano del Seguro Social, México City, Mexico

    Jorge Vela-Ojeda & Miriam A. García-Ruiz-Esparza

Authors
  1. Guillermo J. Ruiz-Argüelles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Gómez-Almaguer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jorge Vela-Ojeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amelia Morales-Toquero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. José David-Gómez-Rangel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Miriam A. García-Ruiz-Esparza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Briceida López-Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Olga G. Cantú-Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. César H. Gutiérrez-Aguirre
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guillermo J. Ruiz-Argüelles.

About this article

Cite this article

Ruiz-Argüelles, G.J., Gómez-Almaguer, D., Vela-Ojeda, J. et al. Extramedullary Leukemic Relapses Following Hematopoietic Stem Cell Transplantation with Nonmyeloablative Conditioning. Int J Hematol 82, 262–265 (2005). https://doi.org/10.1532/IJH97.04195

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1532/IJH97.04195

Key words

Search

Navigation