Graft failure following hematopoietic stem cell transplantation (HSCT) is an uncommon complication associated with significant morbidity and mortality, prompting the need for further therapy. Although this complication could be overcome by hematopoietic growth factors, augmented immunosuppression, donor leukocyte infusions, and second HSCT with or without preparative conditioning, its treatment success remains limited. More recently, however, several promising approaches have been developing. This report will review the various studies that have attempted to define diagnosis, prognosis and therapy of graft failure.
The probability of survival of pediatric aplastic anemia after hematopoietic stem cell transplantation (allo-HSCT) has become excellent, but only limited data are available regarding health condition and social status. In this study, to obtain fundamental information about pediatric aplastic anemia, we performed a surveillance study for aplastic anemia patients who received allo-HSCT and became 20 years or older. Replies were obtained from 12 out of 18 patients (66.7％). Excluding 2 patients with Fanconi anemia, 1 of 10 patients had a body height of less than －2SD. Eight of 10 females had menses. Among 3 married females, 4 pregnancies were reported in 2 patients, and 3 pregnancies resulted in live healthy births. Performance status (PS) of 9 out of the 12 patients was 0. Our study showed that pediatric aplastic anemia patients could have good health condition and social status, but some patients suffered low PS or amenorrhea. To establish optimal treatment for pediatric aplastic anemia, a long-term follow-up system is required.
Human herpesvirus 6 (HHV-6) causes life-threatening limbic encephalitis encephalitis following allogeneic haematopoietic transplantation (HSCT). We describe two patients with post-transplant HHV-6 encephalitis who were treated with corticosteroid pulse therapy. Underlying diseases were myelodysplastic syndrome and relapsing acute myeloid leukemia. Pre-engraftment immunoreaction (PIR) was recognized before the onset of HHV-6 encephalitis in both patients. They were given antiviral agents with steroid pulse therapy, and disturbed consciousness was ameliorated, but eventually died afterwards. One patient died of cerebral vascular infarction and another of severe acute graft versus host disease (GVHD). Steroid pulse therapy may be effective for HHV-6 encephalitis following allogeneic HSCT. In addition, supportive therapy is important for improving the prognosis of HHV-6 encephalitis.
Lenalidomide is indicated for treatment of patients with relapsed or refractory multiple myeloma. The main toxicities related to this drug are severe neutropenia and thrombocytopenia. Lenalidomide-associated eosinophilic pneumonia with skin rash is rare. We report a patient who developed dyspnea with skin rash during lenalidomide treatment for relapsed myeloma three and a half years after allogeneic hematopoietic stem cell transplantation (allo- HSCT). Bronchoalveolar lavage (BAL) analysis revealed increased eosinophils, but no sign of infection. Skin biopsy findings showed graft-versus-host disease (GVHD). We made a diagnosis of eosinophilic pulmonary syndrome associated with GVHD. This case suggests that even three and a half years after performing allo-HSCT, lenalidomide therapy may induce GVHD. Consequently, lenalidomide therapy in such patients should be applied carefully while taking GVHD into consideration.