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Central pontine myelinolysis following bone marrow transplantation complicated by severe hepatic veno-occlusive disease

Bone Marrow Transplantation volume 36, pages 733–734 (2005)Cite this article

A 13-year-old boy was diagnosed with AML after a short history of fatigue and pallor. A bone marrow examination demonstrated 40% myeloblasts with morphology consistent with FAB M2 subtype. Cytogenetics demonstrated a clonal abnormality with translocation between chromosomes 8 and 21. He was enrolled on the Childrens Oncology Group pilot study AAML03P1. Accordingly, he received initial induction chemotherapy, which comprised cytarabine 100 mg/m2/dose twice daily for 10 days, daunorubicin 50 mg/m2/day on days 1, 3 and 5, etoposide 100 mg/m2/dose daily on days 1–5 and gemtuzumab ozogamicin 3 mg/m2/dose once on day 6. He achieved a morphological remission and proceeded to consolidation therapy, which comprised the same drugs and doses, but only 8 days of cytarabine and no gemtuzumab. He received a further cycle of consolidation therapy comprising cytarabine 1 g/m2/dose daily for 5 days and etoposide 150 mg/m2/dose daily for 5 days. As an HLA-matched sibling donor was available, he proceeded with bone marrow transplantation.

Following a conditioning regimen of busulfan 0.8 mg/kg/dose i.v. four times daily on days −9, −8, −7, −6 and cyclophosphamide 50 mg/kg/dose daily on days −5, −4, −3, −2, he received 1.49 × 108 nucleated cells/kg (2.27 × 106 CD34 cells/kg) from his brother. Busulfan pharmacokinetic monitoring demonstrated an AUC of 1037 μ M·min (target 900–1350 μ M·min). Graft-versus-host disease (GvHD) prophylaxis was with cyclosporine and methotrexate. Ursodeoxycholic acid 150 mg orally twice a day was administered as VOD prophylaxis.

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Authors and Affiliations

  1. Pediatric Blood and Marrow Transplant Program, University of Minnesota, MN, USA

    C Fraser & P Orchard

  2. Division of Pediatric Neurology, University of Minnesota, MN, USA

    L Charnas

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  1. C Fraser
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  2. L Charnas
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  3. P Orchard
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Fraser, C., Charnas, L. & Orchard, P. Central pontine myelinolysis following bone marrow transplantation complicated by severe hepatic veno-occlusive disease. Bone Marrow Transplant 36, 733–734 (2005). https://doi.org/10.1038/sj.bmt.1705115

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