title: Successful reduced-intensity hematopoietic stem cell transplantation in myelodysplastic syndrome with severe coronary artery disease.
abstract: A 60-year-old Japanese man with myelodysplastic syndrome (MDS) and effort angina was referred to our clinic for treatment of MDS. The patient was transfusion-dependent and displayed coronary artery disease (CAD) with 99% obstruction of the left anterior descending coronary artery. Treatment comprised reduced-intensity hematopoietic stem cell transplantation with administration of fludarabine phosphate (180 mg/m(2)) and busulfan (8 mg/kg), followed by allogeneic peripheral blood stem cell transplantation from an HLA-matched sister. The regimen was well tolerated, and engraftment occurred rapidly without any therapy-related complications, including cardiovascular attack. Sex chromosome analysis by fluorescence in situ hybridization revealed complete donor chimerism on day 29 for bone marrow cells and on day 59 for peripheral blood leukocytes. The patient became transfusion-independent on posttransplantation day 8. As of 22 months postoperatively, he remains well, with 100% Karnofsky performance status, a limited type of chronic graft-versus-host disease, and no recurrence of disease. The clinical course of the patient suggests that this preparative regimen allows safe allogeneic stem cell transplantation for MDS patients with severe CAD.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Akita University School of Medicine, Japan. kosugis@doc.med.akita-u.ac.jp
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kosugi
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirokawa
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Kawabata
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yoshioka
authors.forename: Ikuo
authors.initials: I
authors.lastname: Miura
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Sawada
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003324:Coronary Artery Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D018183:Transplantation Chimera; D014184:Transplantation, Homologous; D016896:Treatment Outcome