Successful nonmyeloablative allogeneic stem cell transplantation for therapy-related acute myelogenous leukemia in a patient with preexisting visceral fungal infection.
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.
Ostronoff
Fabiana
F
Hematology and Bone Marrow Transplantation Unit, Real-Hospital Português, Recife, Pernambuco, Brazil. fao9003@gmail.com
Ostronoff
Mauricio
M
Calixto
Rodolfo
R
Maior
Ana Patricia Souto
AP
Sucupira
Alexandre
A
Florêncio
Rodrigo
R
Domingues
Mariana
M
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
D000666:Amphotericin B