Remission of a lymphoproliferative disorder occurring after second BMT from an unrelated donor in a 5-year-old boy with severe aplastic anemia.
A 5-year-old boy with severe aplastic anemia failed to respond to cyclosporine (CYA), prednisolone and antilymphocyte globulin (ALG). No suitable sibling marrow donor was available, but an HLA-matched unrelated donor was identified. The patient was conditioned with cyclophosphamide (CY), 50 mg/kg/day for 4 days, total nodal irradiation (8 Gy), and ALG 30 mg/kg/day for 3 days. GVHD prophylaxis consisted of daily CYA, methotrexate (MTX) and ALG. The patient failed to achieve sustained engraftment. He was reconditioned with high-dose prednisolone and anti-T lymphocyte monoclonal antibody OKT3. The boy was reinfused with the same donor marrow on day 0 (+49/first BMT). No GVHD prophylaxis was given the second time. He received G-CSF on days 0 to +20 after the second transplant. Full engraftment was achieved on day +16 (+65). However, on day +31 (80) he developed a biopsy-proven B cell lymphoproliferative disorder (BLPD). After the OKT3 administration was stopped and treatment with ganciclovir and high-dose immunoglobulin was initiated, the BLPD resolved and the patient was discharged on day +50 (99). He is currently well with a functioning graft 266 (305) days posttransplant, with no sign of GVHD.
Bader
P
P
Children's University Hospital, Dept. Hematology/Oncology, Tübingen, Germany.
Klingebiel
T
T
Klingel
K
K
Föll
J
J
Beck
J
J
Handgretinger
R
R
Ehninger
G
G
Deeg
H J
HJ
Niethammer
D
D
D000741:Anemia, Aplastic / Q000628:therapy*; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology; D002675:Child, Preschool; D006084:Graft Rejection / Q000517:prevention & control*; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000628:therapy*; D008297:Male; D016853:Muromonab-CD3 / Q000627:therapeutic use*
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3