title: Successful treatment of both acute leukemia and active Crohn's disease after allogeneic hematopoietic stem cell transplantation using reduced-intensity conditioning with fludarabine and busulfan: a case report.
abstract: BACKGROUND
  A 32-year-old man diagnosed with acute myelomonocytic leukemia (M4) concurrently had active Crohn's disease (CD) that was refractory to azathioprine and anti-tumor necrosis factor.
  
  
  METHODS
  He underwent an allogeneic bone marrow transplantation from a one HLA-DR allele-mismatched unrelated donor to achieve the first complete remission of leukemia. The conditioning regimen consisted of fludarabine (180 mg/m(2)) and busulfan (8.0 mg/kg) without T-cell depletion. Graft-versus-host disease (GVHD) prophylaxis included tacrolimus and mycophenolate mofetil. Cefotaxime was prescribed for a secondary bacterial infection in a perianal abscess before the start of conditioning chemotherapy. Although low-grade diarrhea persisted, there were no signs of either acute GVHD or CD in the mucosal biopsy specimens on day 24. Complete remission of leukemia and near remission of CD were sustained for 20 months after transplantation without any immunosuppressive drug.
  
  
  CONCLUSIONS
  Allogeneic heamtopoietic stem cell transplantation with reduced-intensity conditioning is a possible therapeutic option for patients with severe and/or refractory CD.
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Nishimoto
authors.forename: H
authors.initials: H
authors.lastname: Nakamae
authors.forename: K
authors.initials: K
authors.lastname: Watanabe
authors.forename: H
authors.initials: H
authors.lastname: Koh
authors.forename: T
authors.initials: T
authors.lastname: Nakane
authors.forename: M
authors.initials: M
authors.lastname: Ohsawa
authors.forename: T
authors.initials: T
authors.lastname: Arakawa
authors.forename: M
authors.initials: M
authors.lastname: Hino
mesh_terms: D000208:Acute Disease; D064591:Allografts; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D019172:Transplantation Conditioning; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine