Pseudo-autologous hematopoietic SCT as treatment for a patient with multiple myeloma who relapsed following an allogeneic hematopoietic SCT

摘要

We present a case of utilizing pseudo-autologous hematopoietic SCT (pASCT) as a treatment for relapse following allogeneic hematopoietic SCT (alloSCT) in a patient with multiple myeloma. A 39-year-old female was diagnosed with Durie-Salmon stage 2A, IgG lambda multiple myeloma in May 1997. As definitive treatment, she underwent a fully ablative alloSCT with her HLA-matched (6/6 Ag) male sibling as the donor in August 1997. BM with a cell dose of 3.1 x 10~8 nucleated cells/kg was infused. She developed Grade I gut GVHD and Grade II skin GVHD, which responded well to CYA and methylprednisolone. Long-term complications included mild chronic GVHD involving skin and vagina, but active GVHD had disappeared by 3 years after the transplant and she returned to normal life. In August 2009, 12 years after alloSCT, the previously identified paraprotein re-emerged. She was observed for 1 year before initiation of treatment. A BM aspirate showed 1% plasmacytosis, but rare patchy aggregates of plasma cells were also seen. FISH analysis revealed all cells to have a male karyotype (XY). Treatment with lenalidomide and dexamethasone was initiated. Unfortunately, she was admitted to hospital for hypoxia after two cycles. A computed tomography scan chest showed bilateral infiltrates and reactive lymphadenopathy. Testing for infectious etiologies was negative, and a bronchoscopy was unremarkable. Her symptoms quickly responded to prednisone. The cause of the hypoxia was believed to be an interstitial pneumonitis reaction to lenalidomide but pulmonary GVHD could not be excluded. Further therapy with lenalidomide was felt to be contraindicated.