ABSTRACT
Secondary neoplasias are well known consequences of radiotherapy or chemotherapy for a primary cancer. In this report, we describe two rare secondary neoplasias occurring in the same patient: a meningioma-like intracranial tumor and high-risk myelodysplastic syndrome (MDS) of donor-cells origin, both diagnosed simultaneously, 8 years after an allogeneic hematopoietic stem cell transplantation (allo-HSCT) for chronic lymphocytic leukemia (CLL). Due to an engraftment failure during the first allo-HSCT of a matched related donor for CLL treatment, the salvage treatment was a second allo-HSCT. At the moment of meningioma-like tumor diagnosis, the patient was pancytopenic due to high-risk MDS, so it was decided to postpone a surgical intervention until hematological improvement. For the high-risk MDS of donor-cells origin the chosen treatment was induction with intensive chemotherapy. Due to refractory disease, the patient was treated with 5-azacitidine and donor-lymphocytes infusion with no response and, finally, a third allo-HSCT of a matched unrelated donor was performed. The patient died 6 months after the third allo-HSCT, in cytogenetic remission but without hematological recovery, due to an intracranial hemorrhage with origin in the meningioma-like tumor.
ABSTRACT
Late-onset hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT) has been associated with BK virus (BKV). Antiviral drugs are of limited efficacy and the optimal treatment for HC has not yet been established. Hyperbaric oxygen (HBO) may benefit these patients. We, therefore, retrospectively evaluated the effectiveness of HBO therapy in 16 patients with HC after allogeneic HSCT. All 16 patients had macroscopic hematuria and BKV infection. Patients received 100% oxygen in a hyperbaric chamber at 2.1 atmospheres for 90 min, 5 days per week, with a median 13 treatments (range, 4-84). Fifteen patients (94%) showed complete resolution of hematuria. Median urinary DNA BKV titers declined after HBO (P<0.05). Patients started on HBO earlier after diagnosis of HC responded sooner (P<0.05). HBO was generally well tolerated and proved to be a reliable option for this difficult to manage condition.
Subject(s)
BK Virus , Bone Marrow Transplantation , Cystitis/therapy , Hemorrhage/therapy , Hyperbaric Oxygenation/methods , Polyomavirus Infections/therapy , Adolescent , Adult , Cystitis/diagnosis , Cystitis/etiology , Female , Hematologic Diseases/diagnosis , Hematologic Diseases/therapy , Hemorrhage/diagnosis , Hemorrhage/etiology , Humans , Infant , Male , Middle Aged , Polyomavirus Infections/diagnosis , Polyomavirus Infections/etiology , Retrospective Studies , Time Factors , Transplantation, HomologousABSTRACT
A 36-year-old women with chronic myelogenous leukemia in first chronic phase received a bone marrow transplant from her HLA-identical brother. The preparatory regimen consisted of total body irradiation (10 Gy) and cyclophosphamide (60 mg/kg for 2 days). Full engraftment was achieved and the woman was monitored as an outpatient after discharge from hospital on day 35. One year after BMT, while she was on cyclosporin A and steroids because of chronic graft-versus-host disease, the patient developed protein-losing gastropathy associated with cytomegalovirus infection (with no gastrointestinal symptoms), which regressed spontaneously in 4 weeks.
