title: Successful Allogeneic Stem Cell Transplantation for Severe Aplastic Anemia after Treatment of Lymphoproliferative Disorder Caused by Rabbit Antithymocyte Globulin.
abstract: Immunosuppressive therapy (IST) with a combination of antithymocyte globulin (ATG) and cyclosporine (CsA) is an effective therapeutic modality for patients with aplastic anemia (AA) who are not eligible for allogeneic stem cell transplantation (Allo-SCT) from a human leukocyte antigen-identical sibling donor. However, there have been reports of some patients developing lymphoproliferative disorder (LPD) after IST for AA. We herein report a case of a 26-year-old man with severe AA (SAA) complicated by LPD after a single course of IST, who was successfully treated with Allo-SCT from an unrelated donor. Two months after starting IST for SAA, he developed LPD in the stomach. CsA was reduced, however, his neutrophil counts decreased, and CsA could not be discontinued. The patient was treated with rituximab monotherapy, and LPD resulted in complete remission. However, he failed IST for SAA and underwent Allo-SCT with reduced-intensity conditioning to recover his hematopoiesis. The patient has achieved complete hematopoietic recovery without the recurrence of LPD for five years after transplantation. This is the first report of successful Allo-SCT for SAA after the treatment of LPD caused by the use of rabbit ATG. This case provides useful information for the management of SAA with the development of LPD after IST.
authors.affiliation: Department of Hematology, Chiba University Hospital, Japan.
authors.forename: Shokichi
authors.initials: S
authors.lastname: Tsukamoto
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Nagao
authors.forename: Atsuko
authors.initials: A
authors.lastname: Yamazaki
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Sugita
authors.forename: Tomoya
authors.initials: T
authors.lastname: Muto
authors.forename: Shio
authors.initials: S
authors.lastname: Sakai
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takeda
authors.forename: Naoya
authors.initials: N
authors.lastname: Mimura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Chikako
authors.initials: C
authors.lastname: Ohwada
authors.forename: Emiko
authors.initials: E
authors.lastname: Sakaida
authors.forename: Koutaro
authors.initials: K
authors.lastname: Yokote
authors.forename: Tohru
authors.initials: T
authors.lastname: Iseki
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nakaseko
mesh_terms: D000328:Adult; D000741:Anemia, Aplastic / Q000209:etiology* / Q000601:surgery*; D000818:Animals; D000961:Antilymphocyte Serum / Q000009:adverse effects* / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007958:Leukocyte Count; D008232:Lymphoproliferative Disorders / Q000139:chemically induced* / Q000276:immunology; D008297:Male; D011817:Rabbits; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents