Treatment of an Elderly Patient with Acute Myeloid Leukemia and Invasive Pulmonary Aspergillosis Infection with Combined Allogeneic Hematopoietic Stem Cells Microtransplantation and Voriconazole

Abstract

Invasive aspergillosis infection (IF) in patients with hematologic malignancies is common. Prognosis of IF in patients with acute myeloid leukemia (AML) not responsive to chemotherapy is very poor, especially when neutropenia is duration. Fractional HLA haplo-identical mobilized neutropenia peripheral blood stem cell (PBSC) transfusion, which was defined as micro-transplantation, was recently adopted in treatment of elder patients with AML and shown to be effective in fasting hemopoiesis recovery. Here we report the outcome of an elderly patient with AML accompanying IF treated with microtransplantation and voriconazole. The patient (female, age 62) was diagnosed relapsed AML accompaning suspected invasive fungal infection. She refused to accept further chemotherapy. PBSC from her daughter were collected and transfused fractionally. Voriconazole was used for anti- aspergillosis treatment. After stem cell infusions, the patient’s neutrophil count increased, and platelet transfusion interval extended from 3–4 to 10–14 days. Lung CT indicated that the lesions were significantly absorbed. The patient survived for 257 days. We concluded that for elderly patients with AML and accompanying IF who are not eligible for chemotherapy, microtransplant may be beneficial for improving the efficacy of anti-fungal treatment.