title: Successful nonmyeloablative allogeneic stem cell transplantation for therapy-related acute myelogenous leukemia in a patient with preexisting visceral fungal infection.
abstract: Therapy-related acute myelogenous leukemia (t-AML) is a generally fatal disease with a very poor response to conventional chemotherapy. Allogeneic stem cell transplantation (allo-SCT) has been reported in patients with chemotherapy- responsive t-AML. However its use is limited owing to complications from previous treatments. Nonmyeloablative conditioning provides rapid hematologic engraftment and it is a feasible option for patients who are at increased risk for conventional SCT. There are few data on their use in patients with t-AML. We describe the case of a boy who developed visceral fungal infection with liver abscesses after induction chemotherapy for t-AML. He received allo-SCT with a nonmyeloablative regimen, plus amphotericin B during the transplant procedure. The patient is alive and free of both leukemia and fungal infection 2 years after allo-SCT. Nonmyeloablative allo-SCT may provide durable remission in patients with t-AML, preexisting invasive fungal infections, and a high risk of adverse effects from standard chemotherapy and prolonged cytopenia, without resurgence of the fungal infection.
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, Real-Hospital Português, Recife, Pernambuco, Brazil. fao9003@gmail.com
authors.forename: Fabiana
authors.initials: F
authors.lastname: Ostronoff
authors.forename: Mauricio
authors.initials: M
authors.lastname: Ostronoff
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Calixto
authors.forename: Ana Patricia Souto
authors.initials: AP
authors.lastname: Maior
authors.forename: Alexandre
authors.initials: A
authors.lastname: Sucupira
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Florêncio
authors.forename: Mariana
authors.initials: M
authors.lastname: Domingues
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology*; D002648:Child; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000666:Amphotericin B