Isolated extramedullary cutaneous relapse despite concomitant severe graft-vs.-host disease and tissue chimerism analysis in a patient with acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: A case report

Kantarcioglu,Bulent; Bekoz,Huseyin  Saffet; Ogret,Yeliz  Duvarci; Cakir,Asli; Kivanc,Demet; Oguz,Fatma  Savran; Sargin,Deniz

doi:10.3892/mco.2016.1052

Isolated extramedullary cutaneous relapse despite concomitant severe graft-vs.-host disease and tissue chimerism analysis in a patient with acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation: A case report

Authors:
- Bulent Kantarcioglu
- Huseyin Saffet Bekoz
- Yeliz Duvarci Ogret
- Asli Cakir
- Demet Kivanc
- Fatma Savran Oguz
- Deniz Sargin
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Affiliations: Department of Internal Medicine, Division of Hematology, Istanbul Medipol University, Istanbul 34214, Turkey, Istanbul Medical Faculty, Department of Medical Biology, Istanbul University, Istanbul 34214, Turkey, Department of Pathology, Istanbul Medipol University, Istanbul 34214, Turkey
Published online on: October 19, 2016 https://doi.org/10.3892/mco.2016.1052
Pages: 745-749
Copyright: © Kantarcioglu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment option for patients with acute lymphoblastic leukemia (ALL). The curative potential of allo-HSCT for ALL is, in part, due to the graft‑vs.‑leukemia (GVL) effect, in addition to the intensive conditioning chemo‑radiotherapy. However, relapse remains the major cause of treatment failure following allo‑HSCT for ALL. In the allo‑HSCT setting, testing for genetic markers of hematopoietic chimerism has become a part of the routine diagnostic program. Routine chimerism analysis is usually performed in peripheral blood or bone marrow; in fact, little is known about the value of tissue chimerism in patients with extramedullary relapse (EMR) after the allo‑HSCT setting. The present study reports on, a case of a patient with ALL who experienced isolated cutaneous EMR despite ongoing graft‑vs.‑host disease (GVHD), and the results of peripheral blood and skin tissue chimerism studies using multiplex polymerase chain reaction (PCR) of short tandem repeats (STR‑PCR). The present case demonstrates that, although complete remission and/or chimerism may be achieved in the bone marrow, chimerism achieved at the tissue level, and the subsequent GVL effect, may be limited, despite concomitant severe GVHD following allo‑HSCT. Our tissue chimerism analysis results provide a good example of how skin tissue may be a ‘sanctuary’ site for effector cells of GVL, despite active GVHD and complete hematopoetic chimerism.

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