Relapsed/refractory PBML complicated with failed platelet implantation and mixed infection after allo-HSCT: A case...

Primary bone marrow lymphoma (PBML) is a rare lymphoma with a poor prognosis, characterized by tumor origin restricted to the bone marrow. Diffuse large B-cell lymphoma (DLBCL) is its most common subtype.

We report a case of a 48-year-old female with refractory non-germinal center DLBCL originating in the bone marrow, accompanied by p53 overexpression, complex karyotype, and hemophagocytic lymphohistiocytosis.

Given the aforementioned adverse genetic features, together with primary platelet poor graft function following allogeneic hematopoietic stem cell transplantation (allo-HSCT), mixed infections, severe acute intestinal graft-versus-host disease (GVHD), and progressive bone marrow stromal necrosis, the patient was diagnosed with multifactorial post-transplant poor graft function with bone marrow microenvironment injury.

The patient received induction chemotherapy and achieved complete remission, followed by autologous-hematopoietic stem cell transplantation (autoHSCT) for consolidation. After relapse within 3 months, salvage therapy and subsequent allogeneic-hematopoietic stem cell transplantation were performed.

Despite intensive supportive therapy, the patient died from massive gastrointestinal bleeding. A literature review identified this as a rare case of PBML with primary platelet Poor graft function and mixed infections post-allo-HSCT.

This case highlights the treatment challenges and extremely poor prognosis in ultrahigh-risk PBML with adverse genetic features and severe post-transplant complications.