Abstract：
BACKGROUND: Allogeneic hematopoietic stem cell transplantation is a potentially curative treatment for acute myeloid leukemia. However, extramedullary relapse of acute myeloid leukemia can occur after hematopoietic stem cell transplantation, causing treatment failure. Extramedullary relapse rarely involves the peripheral nerves, and it is not influenced by the effect of the graft on leukemia.
METHODS: We report a case of extramedullary relapse of acute myeloid leukemia in the brachial plexus of a 41-year-old woman treated with allogeneic hematopoietic stem cell transplantation (HSCT). Complete hematological remission was confirmed by bone marrow examination 1 month after HSCT, and she developed no major complications immediately after HSCT. The immunosuppressant was discontinued 5 months later. However, 2 weeks after immunosuppressant withdrawal, the patient developed left arm pain and paresthesia, with subsequent development of a mass in the left brachial plexus. She was initially diagnosed with brachial plexus neuropathy because of concomitant graft-versus-host disease. Despite the administration of immunosuppressive agents, the mass continued to enlarge. The biopsy of the lesion revealed leukemic relapse. Thus, the patient was diagnosed with extramedullary relapse and underwent radiotherapy, resulting in tumor shrinkage.
CONCLUSIONS: Extramedullary relapse should be considered a differential diagnosis in post-transplant patients with leukemia presenting with paresthesia.
METHODS: We report a case of extramedullary relapse of acute myeloid leukemia in the brachial plexus of a 41-year-old woman treated with allogeneic hematopoietic stem cell transplantation (HSCT). Complete hematological remission was confirmed by bone marrow examination 1 month after HSCT, and she developed no major complications immediately after HSCT. The immunosuppressant was discontinued 5 months later. However, 2 weeks after immunosuppressant withdrawal, the patient developed left arm pain and paresthesia, with subsequent development of a mass in the left brachial plexus. She was initially diagnosed with brachial plexus neuropathy because of concomitant graft-versus-host disease. Despite the administration of immunosuppressive agents, the mass continued to enlarge. The biopsy of the lesion revealed leukemic relapse. Thus, the patient was diagnosed with extramedullary relapse and underwent radiotherapy, resulting in tumor shrinkage.
CONCLUSIONS: Extramedullary relapse should be considered a differential diagnosis in post-transplant patients with leukemia presenting with paresthesia.
摘要：
背景：异基因造血干细胞移植是治疗急性髓系白血病的潜在治愈性治疗方法。然而,造血干细胞移植后可发生急性髓系白血病的髓外复发,导致治疗失败。髓外复发很少涉及周围神经，它不受移植对白血病的影响。
方法：我们报告一例41岁女性患者接受异基因造血干细胞移植（HSCT）治疗的臂丛神经髓外复发的急性髓细胞性白血病。HSCT后1个月骨髓检查证实血液学完全缓解，HSCT后，她没有出现重大并发症。5个月后停用免疫抑制剂。然而,免疫抑制剂停药2周后，患者出现左臂疼痛和感觉异常,随后在左臂丛神经形成肿块。由于伴随的移植物抗宿主病，她最初被诊断为臂丛神经病。尽管施用了免疫抑制剂，质量继续扩大。病变的活检显示白血病复发。因此，患者被诊断为髓外复发并接受放疗，导致肿瘤缩小。
结论：髓外复发应视为移植后白血病患者存在感觉异常的鉴别诊断。
方法：我们报告一例41岁女性患者接受异基因造血干细胞移植（HSCT）治疗的臂丛神经髓外复发的急性髓细胞性白血病。HSCT后1个月骨髓检查证实血液学完全缓解，HSCT后，她没有出现重大并发症。5个月后停用免疫抑制剂。然而,免疫抑制剂停药2周后，患者出现左臂疼痛和感觉异常,随后在左臂丛神经形成肿块。由于伴随的移植物抗宿主病，她最初被诊断为臂丛神经病。尽管施用了免疫抑制剂，质量继续扩大。病变的活检显示白血病复发。因此，患者被诊断为髓外复发并接受放疗，导致肿瘤缩小。
结论：髓外复发应视为移植后白血病患者存在感觉异常的鉴别诊断。
