Extramedullary relapse of acute myeloid leukemia in brachial plexus after allogeneic stem cell transplantation: a case report

• Published in: BMC neurology Vol. 22; no. 1; pp. 1 - 241
• Main Authors: Shirota, Shogo, Katoh, Daisuke, Shimomura, Yoshimitsu, Imai, Yukihiro, Ishikawa, Takayuki
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 01-07-2022; BioMed Central; BMC
• Subjects: Acute myeloid leukemia; Allogeneic stem cell transplantation; Biopsy; Bone marrow; Bone marrow transplantation; Brachial nerve; Brachial plexus; Case Report; Case reports; Chemotherapy; Differential diagnosis; Diseases; Extramedullary relapse; Graft versus host disease; Graft-versus-host reaction; Hematology; Hematopoietic stem cells; Immunosuppressive agents; Leukemia; Magnetic resonance imaging; Nervous system; Paresthesia; Patients; Peripheral nerves; Peripheral neuropathy; Radiation therapy; Relapse; Remission; Remission (Medicine); Risk factors; Stem cell transplantation; Transplantation; Tumors; Japan
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-022-02768-1

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. Case presentation 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. Conclusion Extramedullary relapse should be considered a differential diagnosis in post-transplant patients with leukemia presenting with paresthesia. Keywords: Extramedullary relapse, Brachial nerve, Acute myeloid leukemia, Allogeneic stem cell transplantation