Primary graft failure in a patient with refractory acute myeloid leukemia successfully treated with modified ‘one-day’-based preparative regimen followed by cord blood transplantation

KAIUME Hiroko, SUMI Masahiko, KIRIHARA Takehiko, TAKEDA Wataru, KURIHARA Taro, SATO Keijiro, UEKI Toshimitsu, HIROSHIMA Yuki, UENO Mayumi, ICHIKAWA Naoaki, MORI Yuichi, KOBAYASHI Hikaru

doi:10.11406/rinketsu.56.711

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生着不全後‘one-day’ regimen変法を用い臍帯血再移植が奏効した難治性急性骨髄性白血病
症例報告第1回日本血液学会関東甲信越地方会会長推薦演題生着不全後'one-day' regimen変法を用い臍帯血再移植が奏効した難治性急性骨髄性白血病
ショウレイホウコクダイ1カイニホンケツエキガッカイカントウコウシンエツチホウカイカイチョウスイセンエンダイセイチャクフゼンゴ'one-day' regimen ヘンポウオモチイサイタイケツサイイショクガソウコウシタナンチセイキュウセイコツズイセイハッケツビョウ

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Abstract

A 32-year-old woman with acute myeloid leukemia failed to achieve remission with two courses of induction chemotherapy, and she received cord blood transplantation (CBT) in a non-remission state, using an HLA-matched cord blood (CB) graft after a conditioning regimen of fludarabine (Flu) at 125 mg/m²+ melphalan at 140 mg/m²+ total body irradiation (TBI) at 4 Gy. Chimerism analysis of the bone marrow (BM) cells performed on day 21 after CBT revealed 99% of these cells to be the recipient type. We diagnosed the patient as having graft failure (GF), and then carried out a second CBT using an HLA-matched male CB graft on day 29 after the first CBT. The conditioning regimen (modified ‘one-day’-based regimen) consisted of Flu at 30 mg/m² (3 days) + cyclophosphamide (CY) at 2 g/m² (1 day) + TBI 2 Gy. She achieved neutrophil engraftment on day 18. FISH analysis of BM cells on day 13 showed 96% to be of male origin. She has remained in complete remission for 18 months, to date, since the salvage CBT. This case suggests that salvage CBT following a modified ‘one-day’-based regimen may preserve a strong graft versus leukemia effect.

Journal

Rinsho Ketsueki

Rinsho Ketsueki 56 (6), 711-715, 2015

The Japanese Society of Hematology

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