Successful allogeneic bone marrow transplantation in a 2.5-year-old boy with ongoing cytomegalovirus viremia and severe aplastic anemia after orthotopic liver transplantation for non-A, non-B, non-C hepatitis.
BACKGROUND
A 2.5-year-old boy received a cadaveric orthotopic liver transplant for acute liver failure due to non-A, non-B, non-C hepatitis. After transplantation, he developed thrombocytopenia and neutropenia and subsequently severe aplastic anemia. The patient also suffered from recurrent cytomegalovirus (CMV) viremia, treated with foscarnet and ganciclovir.


METHODS
For treatment of his aplastic anemia, the patient underwent an allogeneic bone marrow transplantation from his HLA-identical sister after conditioning with cyclophosphamide at 200 mg/kg and antithymocyte globulin at 3 mg/kg for 5 days. Prophylactic acyclovir was given because of ongoing CMV viremia at the time of bone marrow transplantation.


RESULTS
The transplant course was uneventful, with rapid engraftment. There were no signs of liver dysfunction, graft-versus-host disease, or reactivation of CMV. The patient is in excellent health, with normal liver and bone marrow function 3 years after bone marrow transplantation.


CONCLUSIONS
This case report shows that allogeneic bone marrow transplantation is feasible and well tolerated in a patient with severe aplastic anemia after liver transplantation for acute fulminant viral hepatitis.
Hägglund
H
H
Department of Transplantation Surgery, Huddinge Hospital, Karolinska Institute, Sweden.
Winiarski
J
J
Ringdén
O
O
Sparrelid
E
E
Ericzon
B G
BG
D000741:Anemia, Aplastic / Q000209:etiology; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D016026:Bone Marrow Transplantation; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000097:blood / Q000188:drug therapy; D004279:DNA, Viral / Q000032:analysis; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006525:Hepatitis, Viral, Human / Q000150:complications* / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D016133:Polymerase Chain Reaction
D000998:Antiviral Agents; D004279:DNA, Viral; D017245:Foscarnet; D015774:Ganciclovir