title: Fatal hepatic failure associated with graft rejection following reduced-intensity stem-cell transplantation for chronic idiopathic myelofibrosis (CIMF).
abstract: A 54-year-old man with chronic idiopathic myelofibrosis (CIMF) underwent RIST. His clinical course had been uneventful until day 60, when splenomegaly reappeared. Hepatic dysfunction developed on day 75. Recipient-type hematopoiesis increased to 51% on day 90. After rapid tapering of cyclosporin, serum levels of AST and ALP normalized in parallel with recovery of complete chimerism on day 134. Yet, jaundice progressed. He died of liver failure on day 176. Postmortem examination revealed neither GVHD nor VOD. Graft rejection following RIST for CIMF may lead to fatal hepatic damage through extramedullary hematopoiesis in the liver or cytokine-mediated immune dysregulations.
authors.affiliation: Department of Hematology Toranomon Hospital Tokyo Japan.
authors.forename: Shigesaburo
authors.initials: S
authors.lastname: Miyakoshi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kishi
authors.forename: Naoko
authors.initials: N
authors.lastname: Murashige
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yuji
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusumi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Matsumura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Onishi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Tamae
authors.initials: T
authors.lastname: Hamaki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaue
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
mesh_terms: D002908:Chronic Disease; D017809:Fatal Outcome; D005355:Fibrosis / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D006084:Graft Rejection / Q000150:complications* / Q000473:pathology; D006410:Hematopoiesis; D006801:Humans; D017093:Liver Failure / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013163:Splenomegaly / Q000150:complications / Q000473:pathology / Q000601:surgery; D033581:Stem Cell Transplantation; D015898:Tomography Scanners, X-Ray Computed