engleski

Leukemic phase of anaplastic large cell lymphoma after autologous stem cell transplantation

We report an unusual case of a 40-year old patient with inguinal lymphadenopathy (8 cm in diameter) who was admitted to our hospital in January 1994. Histological examination of lymph nodes revealed anaplastic large-cell lymphoma (Ki-1), bone marrow aspirate showed hypercellularity without neoplastic cells and peripheral blood was normal. He was treated with chemotherapy and complete remission was achieved. Patient first relapsed in July 1996 and again in July 1997 with palpable nodes on right arm. In November 1997 he was treated with BEAM myeloablative chemotherapy followed by autologous stem cell rescue. Both buffy coat from bone marrow harvest and peripheral blood after mobilisation did not show any evidence of characteristic neoplastic cells. Complete remission was achieved. However, the patient relapsed in March 1988 with fever and right axillar lymphadenopathy. Peripheral blood analysis revealed anemia, thrombocytopenia and hyperleucocytosis (109 × 109L) with 39 percent of characteristic anaplastic large cell lymphoma cells (peripheral blood and bone marrow CD 30 and ALCL markers positive, CD3, CD20 and CD15 negative). Abnormal metaphases were found in bone marrow (karyotype: 47, XY, +1, +2, t (3 ; 6) (q27 ; p1),  5, del (13), t (5 ; 13) (q11 ; q32), del 18p). Patient died of sepsis. Leukemia of anaplastic large cell lymphoma is an exceedingly rare event, only few cases have been reported so far. The relation to bone marrow and peripheral stem cell transplantation remains unclear.

Anaplastic large cell lymphoma; leukemia; autologous stem cell transplantation

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