Treatment of secondary myelodysplastic syndrome after heart transplantation with chemotherapy and nonmyeloablative stem-cell transplantation.
BACKGROUND
Treatment of secondary cancer after solid-organ transplantation is difficult because of coexisting medical conditions, reduced organ function, or advanced age in most patients.


METHODS
A 60-year-old man developed treatment-related myelodysplastic syndrome (refractory anemia with excess blasts in transformation) 10 years after orthotopic heart transplantation. After remission induction with chemotherapy, the patient received peripheral blood stem cells from his HLA-identical ABO-mismatched (A-->O) sister after conditioning with fludarabine and low-dose total-body irradiation (200 cGy). Postgrafting immunosuppression consisted of mycophenolate mofetil and cyclosporine A.


RESULTS
The patient experienced little toxicity from the conditioning regimen and achieved complete donor chimerism within 65 days. Five months after transplant, the patient developed pure red cell aplasia that resolved after treatment. At present, he is alive in complete remission with 100% donor hematopoiesis 940 days after stem-cell transplantation.


CONCLUSIONS
Allogeneic blood stem-cell transplantation using minimal conditioning is a new, promising treatment option for patients with hematologic malignancies after solid-organ transplantation.
Kobbe
Guido
G
Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany. kobbe@med.uni-duesseldorf.de
Germing
Ulrich
U
Aivado
Manuel
M
Zohren
Fabian
F
Schubert
Dominik
D
Strupp
Corinna
C
Pape
Hildegard
H
Tenderich
Gero
G
Körfer
Reiner
R
Storb
Rainer
R
Haas
Rainer
R
Schneider
Peter
P
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003561:Cytarabine / Q000008:administration & dosage; D016027:Heart Transplantation; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000209:etiology*; D011183:Postoperative Complications / Q000628:therapy; D033581:Stem Cell Transplantation
D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D008942:Mitoxantrone; D015255:Idarubicin