title: Successful allogeneic bone marrow transplantation for myelodysplastic syndrome complicated by severe pulmonary alveolar proteinosis.
abstract: Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by the abnormal accumulation of alveolar surfactant protein in alveolar spaces. We report herein a rare case of myelodysplastic syndrome (MDS-RAEB) complicated by severe PAP, and successful allogeneic bone marrow transplantation (BMT) for both disorders. An unrelated BMT was planned for a 48-year-old male with advanced MDS-RAEB. Just before the initiation of the conditioning regimen for unrelated BMT in March 2007, he developed dyspnea. A diagnosis of PAP was made based on findings of chest X-ray, CT scanning, and the fluid obtained by bronchoalveolar lavage. To improve his dyspnea and improve BMT safety, whole lung lavage (WLL) was performed twice, with the partial improvement of PAP. Unrelated allogeneic BMT was performed in September 2007. We had to perform a third WLL because of the worsening of PAP on day 26 after BMT. Despite many infectious complications after BMT, GVHD was relatively mild. PAP had almost disappeared 6 months after BMT. He was well with favorable hematopoiesis 20 months after the BMT without any specific treatment. There has been no report of an MDS patient with PAP in whom 3 WLL procedures were performed before and after allogeneic BMT.
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Sumie
authors.initials: S
authors.lastname: Tabata
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Sonoko
authors.initials: S
authors.lastname: Shimoji
authors.affiliation: Department of Pulmonary Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Murase
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Takiuchi
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Daichi
authors.initials: D
authors.lastname: Inoue
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Takaharu
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Nagai
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Togami
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kurata
authors.affiliation: Department of Hematology, Institute of Biomedical Research and Innovation, Kobe, Japan.
authors.forename: Kiminari
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Hematology, Institute of Biomedical Research and Innovation, Kobe, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Hashimoto
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Matushita
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nagai
authors.affiliation: Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe, 650-0046, Japan. sonata53@kcgh.gr.jp.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takahashi
mesh_terms: D016026:Bone Marrow Transplantation; D018893:Bronchoalveolar Lavage; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000628:therapy*; D011649:Pulmonary Alveolar Proteinosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous
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