title: [Effective combination chemotherapy with rituximab for acute lymphoblastic leukemia with bone relapse after bone marrow transplantation].
abstract: A 26-year-old woman with acute lymphoblastic leukemia (ALL) relapsed three times after HLA-matched related bone marrow transplantation. Initially, ALL relapsed in the central nervous system (CNS) 1 year after transplantation. Then, ALL relapsed as a single bone tumor involving the CNS and pelvis 4 years after transplantation. Finally, multiple bone tumors in the pelvis and lumbar bones were found as well as spread to the bone marrow 5 years after transplantation. Bone marrow aspiration also showed ALL relapse. Flow cytometry analyses detected CD20-positive cells in the bone tumor. Though the initial bone tumor was resistant to hyper CVAD, radiation was effective and this patient achieved complete remission. At that time, the total radiation dose had already reached the upper limit. After the third relapse, bone marrow achieved complete remission with the administration of pirarubicin, vincristine, prednisolone, and L-asparaginase (arranged DVP-L), though this combination chemotherapy itself was not effective in multiple bone tumors. Thereafter, arranged DVP-L plus rituximab was administered, which resulted in significant tumor reduction. Biweekly rituximab administration as maintenance therapy has completely prevented the regrowth of bone tumors. Rituximab for relapsed CD20-positive ALL patients after stem cell transplantation could be beneficial.
authors.affiliation: Division of Hematology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science.
authors.forename: Takashi
authors.initials: T
authors.lastname: Abe
authors.forename: Toshiki
authors.initials: T
authors.lastname: Kitajima
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Honma
authors.forename: Tori
authors.initials: T
authors.lastname: Kurasaki
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Okazuka
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Shibasaki
authors.forename: Akihito
authors.initials: A
authors.lastname: Momoi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kuroha
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Masuko
authors.forename: Kumiko
authors.initials: K
authors.lastname: Yagisawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Furukawa
authors.forename: Ken
authors.initials: K
authors.lastname: Toba
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000517:prevention & control; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000517:prevention & control; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000069283:Rituximab