Refractory chronic GVHD emerging after splenectomy in a marrow transplant recipient with accelerated phase CML

Refractory chronic GVHD emerging after splenectomy in a marrow transplant recipient with accelerated phase CML

Author Rodrigues, C. A. Google Scholar
Fermino, Fabiana Aidar Autor UNIFESP Google Scholar
Vasconcelos, Yuri Autor UNIFESP Google Scholar
Oliveira, JSR de Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract We report a 39-year-old female patient who underwent HLA-identical sibling allogeneic BMT for CML in accelerated phase. Severe pancytopenia refractory to G-CSF associated with progressive splenomegaly and RBC/ platelet transfusion dependency were present from day + 60 after BMT. MRD assessed by FISH and RT-PCR multiplex for BCR-ABL rearrangement was negative, and complete chimerism was documented by VNTR on days + 100, + 180, + 360 and 2 years after BMT. Splenectomy was performed on day + 225 and pancytopenia resolved but chronic extensive graft-versus-host disease developed, with hepatic cholestasis, diffuse scleroderma and sicca-like syndrome. She was sequentially and progressively treated with different immunosuppressive therapy combinations with no clear benefit. On day + 940, she presented with infection over the previously present ulcers on both limbs, which culminated in septic shock and death on day + 1041. We conclude that, although splenectomy may reverse poor graft function after allogeneic BMT, hyposplenism may trigger or worsen chronic extensive GVHD leading to increased morbidity and mortality.
Keywords BMT
chronic GVHD
splenectomy
Language English
Date 2003-08-01
Published in Bone Marrow Transplantation. London: Nature Publishing Group, v. 32, n. 3, p. 333-335, 2003.
ISSN 0268-3369 (Sherpa/Romeo, impact factor)
Publisher Nature Publishing Group
Extent 333-335
Origin http://dx.doi.org/10.1038/sj.bmt.1704122
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000184317900015
URI http://repositorio.unifesp.br/handle/11600/27331

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