骨髄移植後再発に対して移植片対白血病効果が有効であった若年型骨髄単球性白血病

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  • Successful Treatment of Relapse after Bone Marrow Transplantation in a Patient with Juvenile Myelomonocytic Leukemia Using Graft-versus-Leukemia Effect.

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A one-year-old boy with juvenile myelomonocytic leukemia underwent bone marrow transplantation from an unrelated female donor. The conditioning regimen included busulfan, cyclophosphamide, cytarabine (Ara-C) and GVHD prophylaxis short-term methotrexate, and cyclosporine A (CsA). On day 22, engraftment was observed, and a previously detected huge splenomegaly was shown to have improved. On days 28, 43, and 69, the male karyotype was detected at a rate of 12/1, 000, 12/1, 000, and 34/1, 000, respectively, by the FISH method, and splenomegaly was increased. After the patient was diagnosed as being in relapse, CsA was discontinued to induce the GVL effect. Rash with itching and severe diarrhea were noted, and the patient was diagnosed as having GVHD (grade III). GVHD improved in response to administration of prednisolone and CsA. After GVHD, no male karyotype was detected, and splenomegaly again improved. The present case suggests that the GVL effect occurs in JMML and that induction of GVL by a cessation of immunosuppressant may be effective in cases showing relapse after hematopoietic stem cell transplantation.

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