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Therapy-related myelodysplastic syndrome after allogeneic BMT: successful treatment by donor lymphocyte infusions

Bone Marrow Transplantation volume 45, pages 1471–1473 (2010)Cite this article

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Therapy-related myelodysplastic syndrome (t-MDS)/AML is a well-described complication of autologous BMT (auto-BMT), but it occurs rarely after allogeneic BMT. We report here a case of t-MDS/AML of recipient origin, associated with high-risk karyotypic abnormalities involving chromosome 7 that presented 1 year after allogeneic BMT for B-ALL and was successfully treated with donor lymphocyte infusions (DLIs).

In February 2006, a 20-year-old man was diagnosed with pre-B ALL (CD34+, CD19+, CD22+, CD20−, CD10+, Cμ+, sIg−). The karyotype was hyperdiploid (55,XY,+X,+4,+6,+14,+17,+18,+21x2,+mar[5]/46,XY[15]). He was enrolled in the multicentric GRAALL 2003 trial and received induction therapy combining VCR, DNR, CY, L-asparaginase, prednisone and intrathecal chemotherapy. The patient was initially steroid- and chemotherapy resistant, but achieved complete haematological and cytogenetic remission after salvage chemotherapy. Unrelated HLA-B-mismatched BMT from a male donor was performed 7 months after diagnosis. The conditioning regimen consisted of high-dose CY, anti-thymoglobulin and 12 Gy fractionated TBI; GVHD prophylaxis consisted of CsA and short-course MTX. On day 23 post transplant, the patient developed grade II cutaneous and gastrointestinal GVHD that was successfully treated with steroids (2 mg/kg/day). Immunosuppressive treatments were gradually tapered 6 months after BMT. Chimerism was 100% donor on day 30 and remained the same for 10 months after BMT. The patient then presented with neutropenia and thrombocytopenia (the ANC fell from 2.5 to 1 g/l and the plt count from 200 to 100 g/l). Concomitantly, analysis of blood chimerism showed 6% recipient cells, which increased to 27% 1 month later, with 40% of recipient cells in the CD3-negative population.

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Authors and Affiliations

  1. Department of Haematology, Hôpital Pitié-Salpêtrière, Paris, France

    D Roos-Weil, S Nguyen, M Uzunov, J-P Vernant & N Dhédin

  2. Haematology Laboratory, Hôpital Henri Mondor, Créteil, France

    D Bories

  3. Cytogenetic Laboratory, Hôpital Pitié-Salpêtrière, Paris, France

    E Chapiro & F Nguyen-Khac

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  1. D Roos-Weil
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Correspondence to N Dhédin.

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Roos-Weil, D., Nguyen, S., Uzunov, M. et al. Therapy-related myelodysplastic syndrome after allogeneic BMT: successful treatment by donor lymphocyte infusions. Bone Marrow Transplant 45, 1471–1473 (2010). https://doi.org/10.1038/bmt.2009.369

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