[Extramedullary relapse in the external auditory canal in a patient with acute promyelocytic leukemia treated with all-trans retinoic acid and autologous peripheral blood stem cell transplantation].
A 41-year-old man was given a diagnosis with of acute promyelocytic leukemia (APL) in August 1994. A chromosome analysis showed 46, XY, t(15; 17) and 47, XY, idem, +8 at that time. Because initial induction chemotherapy (BHAC-DMP) has not been successful, the patient was given 45 mg/m2 of all-trans retinoic acid (ATRA) and achieved complete remission (CR) after 26 days on this regimen. Following intensified chemotherapy, he received an autologous peripheral blood stem cell transplant (PBSCT) with high-dose busulfan and cyclophosphamide in April 1995. Competitive RT-PCR for PML-RAR alpha mRNA did not find any of APL cells in the collected stem-cell fraction. Although the patient remained in CR without therapy, a myeloblastoma was found in his left external auditory canal in August 1996. Recurrence in bone marrow, moreover, was discovered the following month. A chromosome analysis of bone marrow cells showed 47, XY, t(15; 17), +8 at this time. Thus, the extramedullary relapse developed after autologous PBSCT. This case provides information linking ATRA to the development of extramedullary relapse in patients with APL.
Yagita
M
M
Department of Clinical Immunology and Hematology, Tazuke-kofukai Medical Research Institute, Kitano Hospital.
Onishi
R
R
Yamagata
N
N
Shimazaki
C
C
Kudoh
H
H
Kobayashi
M
M
Hikiji
K
K
Konaka
Y
Y
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003131:Combined Modality Therapy; D004424:Ear Canal / Q000473:pathology; D004428:Ear Neoplasms / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000473:pathology* / Q000628:therapy; D008297:Male; D012008:Recurrence; D014212:Tretinoin / Q000009:adverse effects*
D000970:Antineoplastic Agents; D014212:Tretinoin