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The effect of donor leukocyte infusion on refractory pure red blood cell aplasia after allogeneic stem cell transplantation in a patient with myelodysplastic syndrome developing from kostmann syndrome

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Abstract

We describe the clinical course of a patient who experienced refractory pure red cell aplasia (PRCA) after undergoing HLA-matched allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for refractory anemia with an excess of blasts in transformation that had evolved from Kostmann syndrome. The treatment for patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) developing from Kostmann syndrome has not been standardized. We treated this patient with allo-PBSCT using a regimen combining high-dose cytosine arabinoside with granulocyte colony-stimulating factor, in addition to total body irradiation and cyclophosphamide without preceding intensive chemotherapy. The donor was ABO incompatible. Myeloid and platelet recoveries were achieved rapidly. Erythroid engraftment was not evident, however, and the patient was given a diagnosis of PRCA. Regimen-related toxicity and graft-versus-host disease (GVHD) were limited. The PRCA did not respond to various therapies, including the discontinuation of immunosuppressants for the induction of chronic GVHD, human recombinant erythropoietin, immunosuppressive treatment with steroids, cyclosporin A, and human anti-CD20 antibody (rituximab). The patient received transfusions 48 times until the resolution of his anemia by donor leukocyte infusion (DLI) at 25 months after PBSCT. He is now clinically well (performance status, 100%) with normal blood cell counts at 5 years after SCT. An in vitro study demonstrated that serum from the recipient blocked the differentiation of erythroid cells in the bone marrow. The results indicate that the conditioning regimen we describe seems safe and effective for those who have MDS/AML and that DLI might be a valuable approach for refractory PRCA after ABO-incompatible SCT.

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Authors and Affiliations

  1. Department of Pediatric Hematology-Oncology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, 108-8639, Tokyo, Japan

    Yasuhiro Ebihara, Toshihisa Tsuruta, Kumiko Ishikawa, Yoshitoshi Ohtsuka, Hirohide Kawasaki & Kohichiro Tsuji

  2. Department of Pediatrics, St. Luke’s International Hospital, Tokyo, Japan

    Atsushi Manabe & Daisuke Hasegawa

  3. Department of Transfusion Medicine, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    Kazuo Ogami & Yuka Wada

  4. Department of Pediatrics, NTT Kanto Medical Center, Tokyo, Japan

    Tadayasu Kanda

Authors
  1. Yasuhiro Ebihara
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  2. Atsushi Manabe
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  3. Toshihisa Tsuruta
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  4. Kumiko Ishikawa
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  5. Daisuke Hasegawa
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  6. Yoshitoshi Ohtsuka
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  7. Hirohide Kawasaki
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  8. Kazuo Ogami
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  9. Yuka Wada
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  11. Kohichiro Tsuji
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Correspondence to Yasuhiro Ebihara.

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Ebihara, Y., Manabe, A., Tsuruta, T. et al. The effect of donor leukocyte infusion on refractory pure red blood cell aplasia after allogeneic stem cell transplantation in a patient with myelodysplastic syndrome developing from kostmann syndrome. Int J Hematol 86, 446–450 (2007). https://doi.org/10.1007/BF02984003

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  • DOI: https://doi.org/10.1007/BF02984003

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