Spontaneous complete remission and recovery of donor haemopoiesis without GVHD after relapse and apparent marrow graft rejection in poor-prognosis myelodysplastic syndrome.
We report a patient with poor-prognosis myelodysplastic syndrome (MDS) after successful treatment of lymphoma, who was given an allogeneic BMT, engrafted and achieved complete remission, but later had a relapse of his MDS with complete disappearance of donor haemopoiesis. After two episodes of CMV pneumonia and continued prophylactic use of ganciclovir thereafter, he experienced a spontaneous complete disappearance of all signs of MDS, including myelofibrosis, and a complete return to donor haemopoiesis. This case is the first one to suggest a graft-versus-leukaemia effect (GVL) in MDS patients. It depicts the complex relationship between GVL, graft-versus-host disease (GVHD) and graft rejection. It could also constitute a clinical illustration of the possible antileukaemic effect of CMV infection and its treatment with ganciclovir.
Beguin
Y
Y
Department of Medicine, University of Liège, Belgium.
Collignon
J
J
Laurent
C
C
Fillet
G
G
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000379:methods; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006084:Graft Rejection; D006086:Graft vs Host Disease / Q000209:etiology; D006410:Hematopoiesis; D006801:Humans; D015477:Leukemia, Myelomonocytic, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D009190:Myelodysplastic Syndromes / Q000097:blood*; D012008:Recurrence
D000998:Antiviral Agents; D015774:Ganciclovir