Marrow aplasia developing 13 years after HLA-identical sibling allogeneic transplantation for chronic myeloid leukaemia: successful treatment with antithymocyte globulin and peripheral blood stem cell infusion from the original donor.
Secondary or late graft failure has been defined as the development of inadequate marrow function after initial engraftment has been achieved. We describe a case of profound marrow aplasia occurring 13 years after sibling allogeneic bone marrow transplantation for chronic myeloid leukaemia (CML) in first chronic phase. Although the patient remained a complete donor chimera, thereby suggesting that an unselected infusion of donor peripheral blood stem cells (PBSC) or bone marrow might be indicated, the newly acquired aplasia was thought to be immune in aetiology and some immunosuppression was therefore considered appropriate. Rapid haematological recovery was achieved after the infusion of unselected PBSC from the original donor following conditioning with anti-thymocyte globulin (ATG).
O'Donghaile
D
D
Durkan Building, Trinity Centre, Department of Haematology, St James's Hospital, Dublin 8, Ireland. diarmaid@domhan.net
Hayden
P J
PJ
McCarron
S L
SL
Doyle
E M
EM
Lawler
M
M
Browne
P V
PV
Conneally
E
E
Vandenberghe
E
E
McCann
S R
SR
D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001855:Bone Marrow Diseases / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000628:therapy; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D035781:Siblings; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000961:Antilymphocyte Serum