title: Late relapse of acute myelogenous leukemia followed by epstein-barr virus-associated lymphoproliferative disease 11 years after allogeneic bone marrow transplantation.
abstract: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) following myeloablative conditioning represents the treatment of choice for patients with chemotherapy-resistant leukemia. We describe a 49-year-old man with advanced, refractory acute myelogenous leukemia (AML) that was treated successfully by allogeneic bone marrow transplantation from a sibling donor with HLA mismatched at 1 locus. However, the patient developed a quiescent form of chronic graft-versus-host disease (GVHD) 7 years after transplantation, requiring long-term immunosuppressive therapy. AML relapse was documented 11 years after transplantation. Subsequently, Epstein-Barr virus (EBV)-associated posttransplantation lymphoproliferative disorder (PTLD) was also diagnosed. Immune reconstitution after allo-HSCT might have been impaired by the persistent chronic GVHD and the prolonged administration of immunosuppressive agents. As a result, immune surveillance against remaining quiescent leukemic cells as well as viral infection may have been defective, leading to the relapse of leukemia and EBV-associated PTLD.
authors.affiliation: Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors.forename: Yoshikane
authors.initials: Y
authors.lastname: Kikushige
authors.forename: Ken
authors.initials: K
authors.lastname: Takase
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Akihiko
authors.initials: A
authors.lastname: Numata
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kamesaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
authors.forename: Koji
authors.initials: K
authors.lastname: Nagafuji
authors.forename: Hisashi
authors.initials: H
authors.lastname: Gondo
authors.forename: Mine
authors.initials: M
authors.lastname: Harada
mesh_terms: D016026:Bone Marrow Transplantation; D020031:Epstein-Barr Virus Infections / Q000209:etiology / Q000821:virology; D004854:Herpesvirus 4, Human; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000628:therapy / Q000821:virology; D008232:Lymphoproliferative Disorders / Q000821:virology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D014184:Transplantation, Homologous