title: The effect of donor leukocyte infusion on refractory pure red blood cell aplasia after allogeneic stem cell transplantation in a patient with myelodysplastic syndrome developing from Kostmann syndrome.
abstract: We describe the clinical course of a patient who experienced refractory pure red cell aplasia (PRCA) after undergoing HLA-matched allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for refractory anemia with an excess of blasts in transformation that had evolved from Kostmann syndrome. The treatment for patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) developing from Kostmann syndrome has not been standardized. We treated this patient with allo-PBSCT using a regimen combining high-dose cytosine arabinoside with granulocyte colony-stimulating factor, in addition to total body irradiation and cyclophosphamide without preceding intensive chemotherapy. The donor was ABO incompatible. Myeloid and platelet recoveries were achieved rapidly. Erythroid engraftment was not evident, however, and the patient was given a diagnosis of PRCA. Regimen-related toxicity and graft-versus-host disease (GVHD) were limited. The PRCA did not respond to various therapies, including the discontinuation of immunosuppressants for the induction of chronic GVHD, human recombinant erythropoietin, immunosuppressive treatment with steroids, cyclosporin A, and human anti-CD20 antibody (rituximab). The patient received transfusions 48 times until the resolution of his anemia by donor leukocyte infusion (DLI) at 25 months after PBSCT. He is now clinically well (performance status, 100%) with normal blood cell counts at 5 years after SCT. An in vitro study demonstrated that serum from the recipient blocked the differentiation of erythroid cells in the bone marrow. The results indicate that the conditioning regimen we describe seems safe and effective for those who have MDS/AML and that DLI might be a valuable approach for refractory PRCA after ABO-incompatible SCT.
authors.affiliation: Department of Pediatric Hematology-Oncology, Institute of Medical Science, University of Tokyo, 4-6-12 Shirokanedai, Minato-ku, Tokyo, Japan. ebihara@ims.u-tokyo.ac.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ebihara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Manabe
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Tsuruta
authors.forename: Kumiko
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hasegawa
authors.forename: Yoshitoshi
authors.initials: Y
authors.lastname: Ohtsuka
authors.forename: Hirohide
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Ogami
authors.forename: Yuka
authors.initials: Y
authors.lastname: Wada
authors.forename: Tadayasu
authors.initials: T
authors.lastname: Kanda
authors.forename: Kohichiro
authors.initials: K
authors.lastname: Tsuji
mesh_terms: D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage; D006085:Graft Survival; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D017708:Leukocyte Transfusion; D019520:Living Donors; D008297:Male; D019653:Myeloablative Agonists / Q000008:administration & dosage; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000628:therapy*; D038042:Myelopoiesis; D036102:Peripheral Blood Stem Cell Transplantation; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000209:etiology / Q000628:therapy*; D012074:Remission Induction; D013577:Syndrome; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation
chemical_list: D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide