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Adoptive immunotherapy after bone marrow transplantation in a patient with relapsed acute myeloid leukaemia and severe psoriasis

Bone Marrow Transplantation volume 34, pages 281–282 (2004)Cite this article

We would like to bring to your attention a case of a 31-year-old male who presented in November 1984 feeling generally unwell with nausea, weight loss and shortness of breath. Full blood count showed Hb 6.5 g/dl, WBC 122 × 109/l, plts 24 × 109/l and 40% blasts were present in the bone marrow. Cytogenetic analysis was not available at that time. A diagnosis was made of acute myelomonocytic leukaemia secondary to previous treatment with razoxane for severe psoriasis, which had caused multiple episodes of erythroderma and frequent hospitalisation over the previous 20 years. This drug had been discontinued 3 months previously due to case reports of secondary AML with its use. Remission induction was with the standard DAT 3+10 regime. Complete remission was documented after this first course, which was followed by four courses of DAT 1+5 maintenance therapy. A T-cell-depleted allogeneic transplant was carried out in August 1985 using marrow harvested from an HLA-identical sibling. Conditioning therapy was with cyclophosphamide and total body irradiation. Resolution of psoriasis was noted at this stage. In October 1986, there was relapse of AML with Hb 8.3 g/dl, WBC 23.3 × 109/l, plts 26 × 109/l and 30% blasts in the bone marrow. It was decided to undertake a T-cell replete transplant from the same donor. A reduced intensity conditioning regime was used consisting of cytosine arabinoside 2.25 g/m2 i.v. in divided doses daily for 2 days followed by cyclophosphamide 60 mg/kg once daily i.v. for 2 days. The post transplant period was uneventful. Neutrophils reached 1.0 × 109/l at day 35 and plts reached 50 × 109/l at day 49. There was no evidence of acute or chronic GVHD and cyclosporine was withdrawn at 10 months post transplant.

The patient is now in complete remission with no evidence of a psoriatic rash 17 years post nonmyeloablative transplant. At a recent outpatient review, full blood count showed Hb 14.6 g/dl, WBC 7.8 × 109/l and plts 267 × 109/l. In the interim, he has been diagnosed with renal artery stenosis resulting in hypertensive renal impairment. He has also developed ischaemic heart disease, suffering two myocardial infarctions and requiring coronary angioplasty.

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Authors and Affiliations

  1. Department of Haematology, Belfast City Hospital, Belfast, Northern Ireland

    P Windrum & F G C Jones

  2. Department of Haematology, Belfast City Hospital, Belfast, Northern Ireland

    M F McMullin

  3. The Queen's University, Belfast, Northern Ireland

    M F McMullin

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  1. P Windrum
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  2. F G C Jones
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  3. M F McMullin
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Windrum, P., Jones, F. & McMullin, M. Adoptive immunotherapy after bone marrow transplantation in a patient with relapsed acute myeloid leukaemia and severe psoriasis. Bone Marrow Transplant 34, 281–282 (2004). https://doi.org/10.1038/sj.bmt.1704558

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