Discontinuation of Methotrexate after Related Bone Marrow Transplantation Intensify the Graft-versus-Leukemia Effect in a Case of Juvenile Myelomonocytic Leukemia without Obvious Graft-versus-Host Disease
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We report a 7-month-old girl at onset of juvenile myelomonocytic leukemia (JMML) demonstrating huge splenomegaly. The patient was treated by related bone marrow transplantation (r-BMT). According to MDS99, the conditioning regimen consisted of BU, Ara-C and CY, and only MTX was given for graft-versus-host disease (GVHD) prophylaxis. The post-transplant course was uneventful. She never developed severe infection and there was no evidence of clinically obvious symptoms of acute or chronic GVHD such as exanthema, diarrhea or liver dysfunction. However thrombocytopenia persisted and immature myeloid cells were seen in the peripheral blood. Following discontinuation of MTX on day 60 after r-BMT according to MDS99, huge splenomegaly started to reduce and platelet count increased gradually. We think graft-versus-leukemia (GVL) effect was induced only by discontinuation of the immunosuppressive agent. Immunosuppressive agents for post-transplant GVHD should be reduced in cases at low risk of GVHD such as related HLA-full matched BMT.
- 特定非営利活動法人 日本小児血液・がん学会の論文
特定非営利活動法人 日本小児血液・がん学会 | 論文
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