抄録
This report describes a 32-year-old female with acute lymphoblastic leukemia (ALL) successfully grafted with bone marrow from a male HLA identical sibling.
In August 1975, she was diagnosed as having ALL cytologically and achieved complete remission with multi-combination chemotherapy. This remission was terminated by the advent of CNS leukemia after 8 months' maintenance treatment. Also she was in bone marrow relapse. Fortunately she entered the 2nd remission with an intensive chemotherapy including courses of intrathecal methotrexate.
However, she relapsed again in January 1977 and became refractory to the conventional chemotherapy.
In April 1977, she was transferred to the Nagoya University Hospital for bone marrow transplantation (BMT).
Prior to BMT, she was conditioned for grafts with cyclophosphamide, 60mg/kg/day for two days, followed by 1,000 rads total body irradiation (TBI). Bone marrow cells (1.2×1010) from her HLA matched sibling were infused intravenously 24 hours after TBI.
Bone marrow examination on 32nd day after BMT showed a hypocellular marrow with normal hematopoietic elements. Karyotypically, successful engraftment has been demonstrated by full replacement of bone marrow and peripheral blood cells with donor (male) origin.
She received intermittent methotrexate therapy after BMT to prevent graft vs host disease (GVHD). However, mild GVHD developed 3 weeks after BMT which was well controlled with methotrexate and prednisolone. She began to complain of dyspnea on 90th day after BMT and was diagnosed interstitial pneumonia on the chest X-ray film. She died with acute respiratory failure on day 98 after BMT.
An autopsy finding revealed interstitial pneumonia of unknown etiology. GVHD lesions were slightly noted in the skin and liver. Lymphoid tissue was severely atrophied, however, there was no infiltration of leukemia cells in any tissue.
