[Successful treatment with combined anti-thymocyte globulin and methylprednisolone for bronchiolitis obliterans after allogeneic bone marrow transplantation in a child with chronic myelogenous leukemia].
A 9-year-old boy with secondary chronic myelogenous leukemia after treatment of acute lymphoblastic leukemia underwent allogeneic bone marrow transplantation (BMT) from an HLA-identical sibling in December 1998. Grade II acute GVHD developed on day 24 and chronic GVHD developed 5 months after BMT. Cough and dyspnea appeared 9 months after BMT. Despite administration of tacrolimus and methylprednisolone (m-PSL) pulse therapy, the dyspnea gradually increased in severity. Bronchiolitis obliterans was diagnosed on the basis of lung biopsy in January 1999. Because renal dysfunction made it difficult to continue the use of tacrolimus, we attempted antithymocyte globulin (ATG) + m-PSL therapy. Major BCR/ABL mRNA was transiently positive on RT-PCR after the ATG + m-PSL therapy, but no severe complications were observed. A decreasing V50/V25 level and increasing peak flow value were observed in respiratory function tests after ATG + m-PSL therapy, and the patient is currently free of dyspnea. Our findings suggest that ATG + m-PSL therapy is beneficIal for patients with drug-resistant bronchiolitis obliterans after BMT.
Sano
Hideki
H
Department of Pediatrics, Fukushima Medical University School of Medicine.
Kikuta
Atsushi
A
Ito
Masaki
M
Nemoto
Kenji
K
Hojo
Hiroshi
H
Ohto
Hitoshi
H
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000628:therapy*; D002648:Child; D004359:Drug Therapy, Combination; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000628:therapy
D000893:Anti-Inflammatory Agents; D000961:Antilymphocyte Serum; D008775:Methylprednisolone