Philadelphia chromosome-positive acute lymphoblastic leukemia complicated by bone marrow necrosis during consolidation chemotherapy

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Other Title
  • 地固め療法中に骨髄壊死を発症したフィラデルフィア染色体陽性急性リンパ芽球性白血病
  • 症例報告 地固め療法中に骨髄壊死を発症したフィラデルフィア染色体陽性急性リンパ芽球性白血病
  • ショウレイ ホウコク ジガタメ リョウホウ チュウ ニ コツズイ エシ オ ハッショウ シタ フィラデルフィア センショクタイ ヨウセイ キュウセイ リンパ ガキュウセイ ハッケツビョウ

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Description

<p>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.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 61 (5), 462-467, 2020

    The Japanese Society of Hematology

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