Since April 1974, we have clinically applied bone marrow transplantation for the treatment of severe refractory aplastic anemia and acute leukemia.
A 27-year-old male with acute monocytic leukemia was successfully grafted with bone marrow from his HLA-A, B, D matched brother. At the time of transplantation, he was in progressive relapse and resistant to conventional chemotherapy, including combinations of daunomycin, cytosine arabinoside, 6-mercaptopurine and prednisolone. Prior to transplantation, he was conditioned for grafting with cyclophosphamide (CY), 60 mg/kg on each of two successive days, followed by 1000 rads total body irradiation (TBI). Marrow cells (1.4×1010) was infused 96 hr after the last dose of CY and within 24 hr of TBI. Successful engraftment has been accomplished, as documented by the appearance of graft-versus-host reaction (GVHR) and a rising WBC in the recipient. Marrow examination studied 20 days after transplantation showed a hypocellular marrow but all hemopoietic elements were present. He received intermittent methotrexate therapy aftergrafting to modify GVHR. However, associated with the gradually rising WBC, GVHR became apparent with an erythematous macropapular rash, increasing liver function abnormality and anorexia, complicated by a fever of unknown origin. In July, 1976, he developed localized periotonitis in the lower abdomen, associated with interstitial pneumonia. He died on day 68 with respiratory failure.
An autopsy showed cardiopulmonary failure secondary to disseminated cytomegalovirus infection leading to death. GVHR lesions were noted in the skin, liver and gut with severe lymphoid atrophy. There was normocellular marrow without leukemia cells.
