Abstract
IntroductionRelapse after allogeneic hematopoietic stem cell transplantation in patients with myelodysplasia is a challenging problem with limited treatment options. Attempts to induce a graft-versus-leukemia effect have been used with limited success. In patients with myelodysplasia, sustained complete remissions have generally been limited to patients with long-term remission after transplant and those with low numbers of marrow blasts.Case presentationWe report the case of a 41-year-old Caucasian woman with relapsed myelodysplastic syndrome and a high blast percentage six months after undergoing an allogeneic transplant who achieved a sustained complete remission after withdrawal of immunosuppression alone.ConclusionThis case highlights the importance of a reasonable period of observation after withdrawing immunosuppression to induce graft-versus-leukemia, and the potential effectiveness of that approach.
Highlights
Relapse after allogeneic hematopoietic stem cell transplantation in patients with myelodysplasia is a challenging problem with limited treatment options
This case highlights the importance of a reasonable period of observation after withdrawing immunosuppression to induce graft-versus-leukemia, and the potential effectiveness of that approach
Withdrawal of immunosuppression and donor lymphocyte infusion (DLI) has been moderately successful in the treatment of relapsed chronic myelogenous leukemia (CML), which is highly sensitive to the GVL effect
Summary
Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for patients with myelodysplastic syndrome (MDS). Cytogenetic analysis continued to demonstrate a normal female karyotype She remained asymptomatic and declined therapy, despite the elevated blast count. She began to develop worsening cytopenias despite a stable blast percentage on repeat bone marrow biopsies and she subsequently developed worsening anemia requiring red blood cell transfusions. On follow-up, approximately a month after stopping immunosuppresion, our patient developed an erythematous, pruritic rash on her upper and lower extremities, accounting for approximately 50% of her body surface area Counts at this time dropped, with a WBC of 98/mm, hemoglobin 8.3g/dL, and a platelet count of 5000/mm. Prednisone 1mg/kg was initiated and lead to a gradual improvement of her rash and liver function tests, and she was tapered off immunosuppression over a six-month period Her blood counts normalized by day 209 and she continued to demonstrate complete donor chimerism. Her blood counts are normal and her leukocytes and T-cells are 100% donor
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