Allogeneic Bone Marrow Transplantation for Children with (Variant Form) Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia in Second Remission; Case Report of a One-Year-Old Girl.

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We report a case of a one-year-old girl with Philadelphia chromosome (Ph1) -positive acute lymphoblastic leukemia (ALL), who received allogeneic bone marrow transplantation during a second remission. The leucocyte count of peripheral blood was 8, 200/μl, 21% of which were blast cells. Bone marrow was occupied with 95.6% of blast cells, diagnosed as FAB L1 on the basis of negative myeloperoxidase and negative periodic acid Schiff staining. Surface marker analysis showed CD19 and HLA-DR positive, and cytogenetic analysis showed t (12 ; 22) (p13 ; q 11), were not typical Philadelphia chromosome. She was treated with prednisolone, vincristine, THP-adriamycin, L-asparaginase and after 56 days of remission her bone marrow relapsed. Reinduction chemotherapy was started with prednisolone, vincristine, methotrexate, L-asparaginase. After she attained remission, she received the bone marrow transplantation from her HLA-identical sister. She has been in complete remission for 20 months after the transplantation. Ph1-positive ALL has a poor prognosis in children. Although, it has been reported that variant translocation cases have a better prognosis than the typical, relapse cases, like our case should require more aggressive therapeutic approach such as marrow transplantation during a remission.
特定非営利活動法人　日本小児血液・がん学会の論文