THIRD ALLOGENEIC SIBLING TRANSPLANTATION FOR ACUTE MYELOID LEUKEMIA: A CASE REPORT
Journal
Haematologica
Date Issued
2005-06
Author(s)
Siljanoski, Nikola
Abstract
The most frequent therapeutic dilemma after leukemia
relapse is allowing any further attempt at leukemia eradication,
or whether to offer only palliative treatment. Remission
induction for AML re lapsing after HSCT can be achieved in
about 40% of patients. We present a case of 34 years female
patient with AML FAB /1.12 with no cytogenetic abnormalities
diagnosed in April 1998. After two induction chemotherapy
cycles (ARA-C 100mg/m) days 1-7 and Doxorubicin 50mg/m'
days 1,3,5) and consolidation with one cycle of high dose
chemotherapy (ARA-C 2x500 mg/m' days 1-6 and Doxorubicin
50mglm' days 4-6) complete remission was achieved. First allogeneic
sibling transplantation was preformed from fresh bone
marrow as source of stem cells and Bu-Cy conditioning, followed
by conventional GVHD prophylaxis with MTX+
Cyclosporine. After 24 months disease relapse was registered.
The patient was treated with induction chemotherapy with
two more cycles of DAE regimen followed by second allogeneic
transplant from the same donor with peripheral blood progenitors
(PBPC). Two years after the second transplant third re lapse
was registered. Remission was achieved with L6 chemotherapy
regimen with low dose cytarabine and thioguanine. After
that, third allogeneic sibling transplantation was performed with
Bu-Cy conditioning, PBPC as source and no GVHD prophylaxis.
The patient is still +180 days in CR after the third allogeneic
transplantation with good quality of life. At the end we can
conclude that leukemia relapse after stem cell transplantation
still remains a significant cause of treatment failure in patients
with acute leukemia. The success of multiple transplants depends
very much on the time interval from the first transplantation,
the intensity of prior the therapy, the risk of high mortality rate due
to increased regimen toxicity (RR1) as well as undelaying disease
and patient performance status prior transplantation.
relapse is allowing any further attempt at leukemia eradication,
or whether to offer only palliative treatment. Remission
induction for AML re lapsing after HSCT can be achieved in
about 40% of patients. We present a case of 34 years female
patient with AML FAB /1.12 with no cytogenetic abnormalities
diagnosed in April 1998. After two induction chemotherapy
cycles (ARA-C 100mg/m) days 1-7 and Doxorubicin 50mg/m'
days 1,3,5) and consolidation with one cycle of high dose
chemotherapy (ARA-C 2x500 mg/m' days 1-6 and Doxorubicin
50mglm' days 4-6) complete remission was achieved. First allogeneic
sibling transplantation was preformed from fresh bone
marrow as source of stem cells and Bu-Cy conditioning, followed
by conventional GVHD prophylaxis with MTX+
Cyclosporine. After 24 months disease relapse was registered.
The patient was treated with induction chemotherapy with
two more cycles of DAE regimen followed by second allogeneic
transplant from the same donor with peripheral blood progenitors
(PBPC). Two years after the second transplant third re lapse
was registered. Remission was achieved with L6 chemotherapy
regimen with low dose cytarabine and thioguanine. After
that, third allogeneic sibling transplantation was performed with
Bu-Cy conditioning, PBPC as source and no GVHD prophylaxis.
The patient is still +180 days in CR after the third allogeneic
transplantation with good quality of life. At the end we can
conclude that leukemia relapse after stem cell transplantation
still remains a significant cause of treatment failure in patients
with acute leukemia. The success of multiple transplants depends
very much on the time interval from the first transplantation,
the intensity of prior the therapy, the risk of high mortality rate due
to increased regimen toxicity (RR1) as well as undelaying disease
and patient performance status prior transplantation.
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