Allogeneic stem cell transplantation without preconditioning in a child with therapy-related myelodysplastic syndrome: A case report. Issue 6 (10th February 2023)

• Record Type: Journal Article
• Authors: Tung, Yi-Ling; Wang, Yi-Lun; Chang, Tsung-Yen; Chiu, Chia-Chi; Wen, Yu-Chuan; Jaing, Tang-Her
• Is Part Of: Medicine. Volume 102:Issue 6(2023)
• Page Start: e32770
• Publication Date: 2023-02-10
• Subjects: hematopoietic stem cell transplantation -- infant acute lymphoblastic leukemia -- recurrent infection -- therapy-related myelodysplastic syndrome; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000032770
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Rationale: Infants with mixed-lineage leukemia (MLL)-rearranged leukemia are usually refractory to standard induction therapy and are not immediate candidates for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Chromosome 11q23 translocations, resulting in MLL rearrangement, have been well characterized in infant acute lymphoblastic leukemia (ALL). While t(4;11) ALL continues to have carry a bleak prognosis, patients with therapy-related myelodysplastic syndrome (t-MDS) have a shorter median overall survival than those compared with de novo MDS. Patient concerns: We describe a child with t-MDS who evolved from MLL-rearranged ALL and was successfully treated with HSCT without toxic preconditioning. Diagnoses: MDS diagnosis was based on morphological characteristics of bone marrow dysplasia in patients with clinical manifestations evidence of hematopoiesis impairments by different combinations of anemia, leukopenia, neutropenia, and thrombocytopenia. Interventions: Although the best donor for allo-HSCT is generally considered an human leukocyte antigen-matched sibling, only ~ 30% of patients have a suitable sibling. HSCT from an unrelated donor is a suitable option for patients with t-MDS who do not have matched sibling donors. Outcomes: Allo-HSCT without recipient preconditioning could be a promising treatment option for t-MDS, especially for patients with recurrent or persistent infections. Lessons: Cytogenetics, prognosis, and treatment of t-MDS are briefly discussed. Preconditioning before allo-HSCT seriously damages immune function. This work reviews our experience with a patient with t-MDS following ALL complicated by recurrent infections, and highlights our choice to omit preconditioning from allo-HSCT.