Early occurrence of an adenocarcinoma after allogeneic bone marrow transplantation in a patient with AML

Several reports have showed an increased risk of secondary malignancies aft er bone marrow transplantation (BMT), especially after total body irradiati on (TBI). We report on a 39-year-old female who underwent BMT with a matche d unrelated donor because of acute myeloid leukemia in second complete remi ssion. Previously, the patient received chemotherapy for induction, consoli dation, maintenance and reinduction after diagnosis of relapse. Conditionin g regimen consisted of cyclophosphamide and TBI. MTX and CSA was administer ed for GvHD prophylaxis. Engraftment was confirmed on day 28. Within 6 mont hs following BMT, no complication occurred. Continuous complete remission w as demonstrated by repeated bone marrow smears. On day 300 the patient comp lained of chest pain and dyspnea. X-ray and CT-scan showed thickening of th e pleura and pleural effusion. A pleuracarcinosis was diagnosed by cytologi c examination of a pleural aspirate. By an open thoracotomy a disseminated inoperable disease became apparent. Diagnosis of an adenocarcinoma was conf irmed by histologic examination. The patient died 2 months later due to dis seminated tumour in complete remission of AML. Solid tumours are rare as se condary malignancies after BMT. Usually the neoplasmas are late events occu rring more than 10 years after BMT. In this case predisposing factors such as genetic disposition, long-term smoking, intensive pretransplant chemothe rapy, TBI and immunosuppression may have lead to the early secondary malign ancy.