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Akute Leukämie nach Nierentransplantation

Acute leukemia after kidney allotransplantation

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Summary

Four cases of acute myelogenous leukemia and six cases of chronic myelogenous leukemia after treatment with azathioprine and prednisone for renal allotransplantation have been described in the literature. We report another two cases of acute leukemia 10 and 5 years after successful renal allotransplantation. Patient 1, a 29-year-old farmer, exhibited the signs of acute lymphatic leukemia resistent to treatment with cytostatic agents. Death was due to pneumonia. Patient 2, a 47-year-old salesman, developed pancytopenia together with splenomegaly. After splenectomy an atypical subacute myeloid leukemia became apparent which was not treated due to withdrawal of the patient. He died 2 months after diagnosis. Both patients received long-term immunosuppressive therapy with azathiopine and prednisone until the leukemia was diagnosed. A relationship between long-term immunosuppression and the occurrence of leukemia is postulated.

Zusammenfassung

In der Literatur sind vier Fälle mit Entwicklung einer akuten myeloischen und sechs Fälle mit Entwicklung einer chronischen myeloischen Leukämie unter Immunosuppression mit Azathioprin und Prednison bei nierentransplantierten Patienten beschrieben. Wir berichten über zwei weitere akute Leukämien während chronischer Immunosuppression bei Zustand nach Nierentransplantation. Der erste, 29jährige Patient entwickelte zehn Jahre nach erfolgreicher Nierentransplantation die Zeichen einer akuten lymphatischen Leukämie. Beim zweiten, 47jährigen Patienten wurden fünf Jahre nach erfolgreicher Nierentransplantation Hepatosplenomegalie und Pancytopenie beobachtet; nach Splenektomie wurde die Diagnose einer subakuten myeloischen Leukämie gestellt. Beide Patienten standen unter langdauernder immunosuppressiver Therapie (Azathioprin und Prednison),die in beiden Fällen nach der Diagnose einer Leukämie abgesetzt wurde. Ein Zusammenhang zwischen dem Auftreten der Leukämie und der chronischen Immunosuppression wird postuliert.

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Frei, D., Binswanger, U., Fehr, J. et al. Akute Leukämie nach Nierentransplantation. Blut 40, 343–348 (1980). https://doi.org/10.1007/BF01025589

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