Bone marrow necrosis after umbilical cord blood transplantation in a patient with pure erythroid leukemia

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  • Nagamatsu Kentaro
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • Takano Kuniko
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • Takata Hiroyuki
    Department of Hematology, Oita Prefectural Hospital
  • Yoshida Natsumi
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • Sato Takako
    Department of Hematology, Oita Kouseiren Tsurumi Hospital
  • Kohno Kazuhiro
    Department of Laboratory, Oita Kouseiren Tsurumi Hospital
  • Ogata Masao
    Department of Hematology, Oita University Hospital
  • Shirao Kuniaki
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine

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  • 同種臍帯血移植後に骨髄壊死を合併したpure erythroid leukemia

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<p> Bone marrow aspiration of a 64-year-old woman with incomplete remission of pure erythroid leukemia revealed leukemic cells 19 days after undergoing a cord blood transplant (CBT). She also developed concurrent idiopathic pneumonia syndrome (IPS) on day 35, and was treated with steroid pulse therapy and etanercept. However, this strategy was ineffective. She developed lower back pain on day 45, and blood findings revealed progressive pancytopenia, and elevated serum T-Bil, ALP and LDH. Serum ferritin was significantly elevated to 186,160 ng/mL. Bone marrow aspiration showed only degenerated necrotic cells, indicating a diagnosis of bone marrow necrosis (BMN). Her general status rapidly deteriorated, mixed acidosis progressed, and she died on day 55 after CBT. An examination of blood cytokines showed elevated levels of tumor necrosis factor receptor 1 before the onset of BMN, and elevated interleukin-6 that was consistent with the onset of BMN. The prognosis of rare BMN that can follow hematological malignancies and infections is poor. In this patient, we supposed that progressive leukemia, in association with some inflammatory cytokines, could result in BMN.</p>

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