Successful HLA-haploidentical peripheral blood stem cell transplantation with posttransplant cyclophosphamide for refractory pediatric acute myeloid leuekmia after repeated <i>Viridans streptococcal</i> sepsis

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  • Tokunaga Minako
    Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Nishikawa Takuro
    Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Abematsu Takanari
    Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Nakagawa Shunsuke
    Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Kurauchi Koichiro
    Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Kodama Yuichi
    Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Tanabe Takayuki
    Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Shinkoda Yuichi
    Department of Pediatrics, Kagoshima City Hospital
  • Okamoto Yasuhiro
    Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Kawano Yoshifumi
    Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University

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  • 敗血症後の非寛解期に移植後シクロフォスファミドを用いたHLA半合致移植を施行した小児急性骨髄性白血病

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Abstract

 We herein describe a 7-year-old male with refractory acute myeloid leukemia who relapsed 9 months after bone marrow transplantation from human leukocyte antigen (HLA) -identical sibling. He received 2 cycles of FLAG chemotherapy, however, complete remission was not obtained. In addition, sepsis due to viridans group streptococci occurred in 2 of 2 courses of chemotherapy. He underwent haploidentical peripheral blood stem cell transplantation (haploPBSCT) from his father. The conditioning regimen consisted of fractionated total body irradiation (9.9 Gy) and fludarabine (120 mg/m2). Tacrolimus, mycophenolate mofetil, and posttransplant cyclophosphamide (PTCy) (50 mg/kg×2) were administered for the prophylaxis of graft versus host disease (GVHD). The patient developed a fever on day 1, which was promptly resolved with PTCy. On day 18, myeloid engraftment was achieved. The patient developed grade I acute GVHD and mucositis. A fourth CR was obtained for 1 month after haploPBSCT. On day 180, he has been in continuous remission while maintaining his quality of life (QOL). Although the use of haploPBSCT with PTCy has been limited in children, this strategy may be potentially less toxic and helpful to maintain or improve the QOL of patients.

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