Japanese Journal of Clinical Oncology 31:290-293 (2001)
© 2001 Foundation for Promotion of Cancer Research
Successful Unrelated Cord Blood Transplantation in Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia During Pulmonary Aspergillosis Treated by Anti-fungal Therapy, Granulocyte Colony-stimulating Factor-mobilized Granulocytes and Surgical Resection: Case Report
1Department of Pediatrics, School of Medicine, Sapporo Medical University, Sapporo and Departments of 2Pediatrics and 3Pathology, Hokkaido Children’s Hospital and Medical Center, Otaru, Japan
A 3-year-old girl with Philadelphia chromosome positive acute lymphoblastic leukemia developed pulmonary aspergillosis during severe neutropenia by re-induction therapy. She was treated by intravenous fluconazole, oral itraconazole with plasma level monitoring and surgical resection of the focus for 3 months after clinical diagnosis of fungal infection was made. Once she had recovered from surgery we attempted to induce remission with anti-fungal treatment. She developed fever and neutropenia and appeared unlikely to remit with conventional chemotherapy. Unrelated one-antigen-mismatched cord blood (CB) transplantation was performed 2 months after the induction therapy. Her pulmonary aspergillosis was reactivated during subsequent conditioning. Anti-fungal drugs were switched to amphotericin B and granulocyte colony-stimulating factor-mobilized granulocyte concentrates were transfused. She obtained engraftment and has maintained complete hematological and molecular remission without signs of aspergillus infection for 13 months so far after transplantation. Even very high-risk transplantation in pediatric patients could be successfully supported by carefully designed intense comprehensive medical care.
+ For reprints and all correspondence: Tooru Kudoh, Department of Pediatrics, School of Medicine, Sapporo Medical University, S1, W16, Chuo-ku, Sapporo 060-8543, Japan. E-mail: tkudoh@sapmed.ac.jp
Abbreviations: CB, cord blood; Ph, Philadelphia chromosome; ALL, acute lymphoblastic leukemia; BMT, bone marrow transplantation; G-CSF, granulocyte colony-stimulating factor; WBC, white blood cell; PDL, prednisolone; VCR, vincristine; CY, cyclophosphamide; DM, daunomycin; L-Asp, L-asparaginase: MTX, methotrexate; Ara-C, cytosine arabinoside; FISH, fluorescence in situ hybridization; RT–PCR, reverse transcriptase–polymerase chain reaction; MIT, mitoxantrone; VP16, etoposide; CT, computed tomography; HLA, human leukocyte antigen; BU, busulfan; IDA, idarubicin; GVHD, graft-versus-host disease; CMV, cytomegalovirus