Five-month marrow aplasia in a child with refractory acute myeloid leukemia: successful management with continuous granulocyte support and reduced-intensity conditioning followed by matched unrelated bone marrow transplantation.
A 10-year-old girl diagnosed with acute myeloid leukemia FAB M4 failed to achieve remission following several courses of induction chemotherapy. From the first course of chemotherapy the patient had continuous marrow aplasia, managed by a total of 57 granulocyte transfusions. After reinduction and reduced-intensity conditioning including fludarabine, Campath-1H, and melphalan, the patient received unmanipulated marrow from an HLA-matched unrelated donor. Leukocyte and platelet engraftment was observed on day +18 and +50, respectively. Graft-versus-host disease did not occur. The patient is alive and well in complete remission 18 months after transplantation with complete donor chimerism.
Benesch
Martin
M
Division of Pediatric Hematology and Oncology, Department of Pediatrics, Medical University of Graz, A-8036 Graz, Austria. martin.benesch@klinikum-graz.at
Sovinz
Petra
P
Lackner
Herwig
H
Schwinger
Wolfgang
W
Dornbusch
Hans Jürgen
HJ
Urban
Christian
C
D000074323:Alemtuzumab; D000741:Anemia, Aplastic / Q000209:etiology* / Q000628:therapy; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006098:Granulocytes / Q000473:pathology; D006801:Humans; D015479:Leukemia, Myelomonocytic, Acute / Q000382:microbiology / Q000628:therapy*; D008558:Melphalan / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000382:microbiology / Q000628:therapy*; D012074:Remission Induction; D018183:Transplantation Chimera; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000074323:Alemtuzumab; D014740:Vidarabine; C024352:fludarabine; D008558:Melphalan