Subject(s)
Adrenal Cortex Hormones/therapeutic use , Antineoplastic Agents/adverse effects , Drug Resistance , Granulocyte Colony-Stimulating Factor/adverse effects , Immunoglobulins, Intravenous/therapeutic use , Multiple Myeloma/drug therapy , Skin/drug effects , Sweet Syndrome/drug therapy , Adult , Biopsy , Humans , Male , Multiple Myeloma/diagnosis , Remission Induction , Severity of Illness Index , Skin/pathology , Sweet Syndrome/chemically induced , Sweet Syndrome/diagnosis , Treatment OutcomeSubject(s)
Antineoplastic Agents/adverse effects , Blood Group Incompatibility/immunology , Hemolysis/immunology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery , Peripheral Blood Stem Cell Transplantation , Transplantation Conditioning/methods , Vidarabine/analogs & derivatives , Female , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology , Middle Aged , Transplantation, Homologous/immunology , Vidarabine/adverse effectsABSTRACT
Therapy-related acute myelogenous leukemia (t-AML) is a generally fatal disease with a very poor response to conventional chemotherapy. Allogeneic stem cell transplantation (allo-SCT) has been reported in patients with chemotherapy- responsive t-AML. However its use is limited owing to complications from previous treatments. Nonmyeloablative conditioning provides rapid hematologic engraftment and it is a feasible option for patients who are at increased risk for conventional SCT. There are few data on their use in patients with t-AML. We describe the case of a boy who developed visceral fungal infection with liver abscesses after induction chemotherapy for t-AML. He received allo-SCT with a nonmyeloablative regimen, plus amphotericin B during the transplant procedure. The patient is alive and free of both leukemia and fungal infection 2 years after allo-SCT. Nonmyeloablative allo-SCT may provide durable remission in patients with t-AML, preexisting invasive fungal infections, and a high risk of adverse effects from standard chemotherapy and prolonged cytopenia, without resurgence of the fungal infection.
Subject(s)
Candidiasis/microbiology , Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/therapy , Amphotericin B/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Candidiasis/drug therapy , Child , Humans , Leukemia, Myeloid, Acute/diagnosis , Male , Transplantation, Homologous , Treatment OutcomeSubject(s)
Hodgkin Disease/diagnosis , Leishmaniasis, Visceral/diagnosis , Lymph Nodes/pathology , Adolescent , Animals , Hodgkin Disease/complications , Humans , Leishmania donovani/isolation & purification , Leishmaniasis, Visceral/complications , Leishmaniasis, Visceral/parasitology , Lymph Nodes/parasitology , MaleABSTRACT
The combination of methotrexate and cyclosporine A (MTX-CSA) is the standard regimen for the prevention of graft vs. host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-SCT) from HLA-identical siblings. Mycophenolate mofetil and CSA (MMF-CSA) combination has been successfully used for GVHD prophylaxis after non-reduced intensity conditioning (non-RIC) allo-SCT with peripheral blood or non-G-CSF stimulated bone marrow as stem cell source. We report the results of the first prospective trial of the MMF-CSA combination for acute GVHD prophylaxis in 47 patients after non-RIC G-CSF stimulated allo-BMT (G-BMT) from HLA-identical siblings in patients with severe aplastic anemia (SAA) or hematological malignancies. Median age was 28 yr (range, 6-48 yr). Median follow-up was 22 months. The median time to neutrophil and platelets recovery were nine d (range, 8-17) and 16 d (range, 10-28), respectively. Acute GVHD of grade II-IV and chronic GVHD occurred in 51% and 27%, respectively. Overall survival rates at two yr for patients with SAA and hematological malignancies were 87% and 65%, respectively. The event-free survival at two yr for patients with hematological malignancies was 76%. We concluded that MMF-CSA appears equivalent to MTX-CSA for GVHD prophylaxis in patients receiving non-RIC G-BMT from HLA-identical siblings, with a tendency for more rapid neutrophil engraftment.