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Bone Marrow Transplantation volume 26, pages 1134–1135 (2000)Cite this article

Extramedullary disease (EMD) after allogeneic bone marrow transplantation (BMT) is not uncommon. Interestingly, many cases occur without morphological evidence of marrow involvement.1 An update of our experience in a single centre showed that isolated EMD after allogeneic BMT occurred in 4/163 patients transplanted for acute myeloid leukaemia (AML), 4/46 patients for acute lymphoblastic leukaemia (ALL), and 4/156 patients for chronic myeloid leukaemia (CML). None of these cases showed marrow involvement morphologically at the time of EMD. In three of the AML cases that received sex-mismatched BMT, fluorescence in situ hybridisation showed complete donor chimerism in the marrow. In 2/3 ALL cases that were positive for the Philadelphia chromosome, reverse transcription polymerase chain reaction (RT-PCR) for m-BCR/ABL did not reveal minimal residual disease (MRD) in the marrow. However, in all the CML cases, RT-PCR for M-BCR/ABL was positive in the marrow when EMD was diagnosed. Therefore, there may be heterogeneity in different cases as to whether the EMD was ‘isolated’, although morphological involvement of the marrow was absent.

The cases described by Schäfer et al2 were informative in showing that donor-derived cells did not infiltrate the EMD, despite partial to complete donor chimerism in the marrow, as assessed by PCR for microsatellite markers with variable number of tandem repeats (VNTR). Rapid systemic relapse occurred in their cases, implying that EMD was but a transient phase heralding marrow involvement. Nevertheless, their findings did support that, at least in the initial stages, the graft-versus-leukaemia (GVL) effect was stronger in the marrow than in extramedullary sites.

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References

  1. Au WY, Kwong YL, Lie A et al. Extra-medullary relapse of leukaemia following allogeneic bone marrow transplantation Hematol Oncol 1999 17: 45–52

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  2. Schäfer H, Bader P, Kaiserling E et al. Extramedullary relapses at uncommon sites after allogeneic bone marrow transplantation Bone Marrow Transplant 2000 26: 1133–1134

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  1. University Department of Medicine, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong

    YL Kwong & WY Au

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  1. YL Kwong
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  2. WY Au
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Kwong, Y., Au, W. Response. Bone Marrow Transplant 26, 1134–1135 (2000). https://doi.org/10.1038/sj.bmt.1702646

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