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Diffuse alveolar hemorrhage following gemtuzumab ozogamicin

Bone Marrow Transplantation volume 35, pages 823–824 (2005)Cite this article

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Diffuse alveolar hemorrhage (DAH) or hemorrhagic alveolitis is a severe, often fatal, pulmonary complication of myeloablative stem cell transplantation (SCT).1 The efficacy of current therapies for DAH remains unproven, although common practice is to treat patients with high-dose, pulsed methylprednisolone.2 The mortality of patients who require intubation and mechanical ventilation for DAH exceeds 80%.3, 4, 5 While primarily a complication of myeloablative SCT in patients with hematologic malignancies, DAH has been described as a rare toxicity of nontransplant therapies. DAH has been observed after use of the antiglycoprotein IIb/IIIa receptor monoclonal antibody abciximab (ReoPro),6, 7 but has not been associated with the humanized anti-CD33 monoclonal antibody gemtuzumab ozogamicin (Mylotarg).

We report a case of DAH in a 51-year-old white male who received two doses of gemtuzumab ozogamicin for relapsed acute myelogenous leukemia (AML) after myeloablative allogeneic SCT. This patient initially achieved complete remission with 3+7 induction chemotherapy with daunorubicin and cytarabine, followed by one cycle of high-dose cytarabine. He relapsed 20 months after his initial diagnosis and received three cycles of mitoxantrone and VP-16, which failed to achieve remission. He underwent myeloablative allogeneic SCT from a matched unrelated donor. His preparative regimen consisted of busulfan 14 mg/kg, VP-16 60 mg/kg and cyclophosphamide 120 mg/kg. He received methotrexate and cyclosporine as graft-versus-host-disease (GVHD) prophylaxis. Day +30 bone marrow biopsy showed remission, but day +162 bone marrow biopsy showed relapsed AML. He received gemtuzumab ozogamicin 9 mg/m2 26 weeks after his SCT. A similar dose was given 14 days later.

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Acknowledgements

We thank Drs Thomas Yunger, Rundsarah Tahboub and Jon Walker for their assistance in the care of this patient. This work was supported in part by The National Institutes of Health (1 K23 CA102276-01A1 to TSL), The Sidney Kimmel Cancer Research Foundation, The Leukemia and Lymphoma Society of America and The D Warren Brown Foundation.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Arthur James Cancer Hospital and Richard Solove Research Institute, The Ohio State University, Columbus, OH, USA

    T S Lin, S L Penza, B R Avalos, S S Farag, J C Byrd & E A Copelan

  2. Division of Pulmonary Diseases, Arthur James Cancer Hospital and Richard Solove Research Institute, The Ohio State University, Columbus, OH, USA

    M R Lucarelli

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  1. T S Lin
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  2. S L Penza
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  3. B R Avalos
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Lin, T., Penza, S., Avalos, B. et al. Diffuse alveolar hemorrhage following gemtuzumab ozogamicin. Bone Marrow Transplant 35, 823–824 (2005). https://doi.org/10.1038/sj.bmt.1704886

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