A case of ovarian recurrence of B-lymphoblastic leukemia that remitted after bilateral salpingo-oophorectomy and unrelated cord blood transplantation

Abstract

We describe the case of a patient with ovarian relapse of B-lymphoblastic leukemia (B-ALL) 4 years after primary diagnosis, who has been in remission following second-line chemotherapy, bilateral salpingo-oophorectomy, and unrelated cord blood transplantation (UR-CBT). A four-year-old girl was diagnosed as having ETV6/RUNX1-positive B-ALL. She achieved complete remission (CR) after treatment in accordance with a BFM-based protocol. Two years after completing chemotherapy, laboratory examination revealed elevated creatinine, BUN, and LDH levels. CT showed bilateral hydronephrosis and ovarian tumors. Ovarian relapse of ALL was confirmed by laparoscopic biopsy. Although she remained in bone marrow remission, FDG-PET-CT demonstrated multiple lesions in the retroperitoneum, mediastinal lymph node, and liver. She achieved a second CR after BFM-oriented chemotherapy for recurrent ALL, followed by bilateral salpingo-oophorectomy and UR-CBT. She has remained in CR for 20 months since UR-CBT. Unlike testicular relapse, ovarian relapse in ALL is rare. This case may provide insight into the management of ovarian relapse in ALL.