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Intensive chemotherapy for a relapsed ALL patient who received living-donor lobar lung transplantation

Bone Marrow Transplantation volume 47, pages 135–136 (2012)Cite this article

Bronchiolitis obliterans (BO) is a slowly progressive, treatment-resistant obstructive lung disease, and only lung transplantation can provide a full recovery. Since Roca et al.1 first reported a patient with irreversible airway obstruction, BO has been considered to be one of the symptoms of chronic GVHD after allogeneic hematopoietic SCT. However, no report has yet documented intensive treatment of the patients who relapse due to underlying hematologic malignancy after receiving living-donor lobar lung transplantation (LDLLT), since LDLLT for such pulmonary complications was first reported in 1989.2 We previously reported a patient with ALL who underwent LDLLT for progressive BO after allo-SCT.3 Unfortunately, she relapsed 66 months after the LDLLT. We herein report a patient who achieved CR by intensive chemotherapy for relapsed ALL after LDLLT.

A 17-year-old ALL female received an allogeneic BMT from her HLA-matched sibling during her first CR in July 1997. Neither acute nor chronic GVHD developed, and relapse was observed in October 2002. After achieving her second CR by combination chemotherapy, she received high-dose cytarabine therapy following PBSC infusion from the same donor as provided the BM. GVHD has not developed, with no immunosuppressant use. Additional donor lymphocyte infusion was administered on day 34. Chronic GVHD developed in the oral mucosa 2 months after donor lymphocyte infusion. A gradual progression of dry cough was observed despite the restart of CsA, and dyspnea on exertion reached grade III on the Hugh–Jones classification. We diagnosed the patient with progressive BO, and she received LDLLT on both sides in February 2004. Her postoperative course was uneventful and she was discharged on day 65. She has maintained CR with mild anemia; however, palpitations and more prominent anemia developed in August 2009. A BM smear showed 88% blasts, indicating a relapse of ALL. Renal dysfunction was observed leading to a high creatinine level with 1.2 mg/dL. Her hepatic function was normal. On arterial blood gas analysis, her pH of 7.36, pCO2 of 35.6 and pO2 of 92.9 were normal.

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Authors and Affiliations

  1. Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan

    K Ishiyama, H Okumura, H Yamazaki, Y Kondo, Y Waseda, T Kotani, A Takami & S Nakao

  2. Division of Hematology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan

    K Ishiyama

  3. Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan

    H Okumura

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  1. K Ishiyama
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  2. H Okumura
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  3. H Yamazaki
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  4. Y Kondo
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  6. T Kotani
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  7. A Takami
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  8. S Nakao
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Correspondence to K Ishiyama.

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Ishiyama, K., Okumura, H., Yamazaki, H. et al. Intensive chemotherapy for a relapsed ALL patient who received living-donor lobar lung transplantation. Bone Marrow Transplant 47, 135–136 (2012). https://doi.org/10.1038/bmt.2011.5

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