Reduced-Intensity Hematopoietic Stem Cell Transplantation for a Patient with Myelodysplastic Syndrome and Chronic Obstructive Pulmonary Disease

Abstract

Allogeneic hematopoietic stem cell transplantation (SCT) following high-dose chemotherapy and total body irradiation (TBI) has improved the prognosis of advanced hematological diseases. In order to assess a patient’s suitability for SCT, a thorough pretransplantation survey is performed. However, patient eligibility has expanded because of the progress of supportive care, so it is difficult to define SCT eligibility limitations due to organ dysfunction. Moreover, recent progress in reduced-intensity stem cell transplantation (RIST) has facilitated the use of SCT in older patients and patients with various underlying diseases [1,2]. This article describes the case of a 65-year-old man with myelodysplastic syndrome (MDS), refractory anemia, and chronic obstructive pulmonary disease (COPD) (emphysema) who underwent SCT. The patient had a history of smoking for more than 40 years and had suffered from Burger’s disease since the age of 40 years. He occasionally complained of lower limb pain and was treated with prostaglandin. In 1998, he presented with anemia, and MDS (refractory anemia) was diagnosed. Two years prior to this report he required frequent red cell transfusions, the frequency of which gradually increased. In June 2004, he was admitted to our hospital for allogeneic hematopoietic SCT. Laboratory examinations confirmed bicytopenia: hemoglobin concentration, 5.7 g/dL; red blood cell count, 2010 109/L; white blood cell count, 3.3 109/L; platelet count, 183 109/L. The bone marrow survey demonstrated normocellular bone marrow with mild dysplasia and a small amount of blasts (<5%). The karyotype analysis showed 3 populations; 4 of 20 analyzed cells were 46XY, del(7)(q20); 3 of 20 analyzed cells were 46XY, +13; the remaining cells were 46XY. Prior to SCT the patient had received a total of 46 transfusions of 2 units of red cells. The pretransplantation Reduced-Intensity Hematopoietic Stem Cell Transplantation for a Patient with Myelodysplastic Syndrome and Chronic Obstructive Pulmonary Disease