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

Bone Marrow Transplantation volume 48, page 1138 (2013)Cite this article

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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 × 108 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.

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References

  1. Powles RL, Parikh PM, Helenglass G, Aboud HH, Smith CL, Mrazek IA et al. Bone-marrow transplant from father to son and subsequent graft from son to father. Lancet 1990; 335: 999–1000.

    Article  CAS  Google Scholar 

  2. Minnema MC, van der Veer MS, Aarts T, Emmelot M, Mutis T, Lokhorst HM . Lenalidomide alone or in combination with dexamethasone is highly effective in patients with relapsed multiple myeloma following allogeneic stem cell transplantation and increases the frequency of CD4+Foxp3+ T cells. Leukemia 2009; 23: 605–607.

    Article  CAS  Google Scholar 

  3. Kneppers E, van der Holt B, Kersten MJ, Zweegman S, Meijer E, Huls G et al. Lenalidomide maintenance after nonmyeloablative allogeneic stem cell transplantation in multiple myeloma is not feasible: results of the HOVON 76 Trial. Blood 2011; 118: 2413–2419.

    Article  CAS  Google Scholar 

  4. Jimenez-Zepeda VH, Mikhael J, Winter A, Franke N, Masih-Khan E, Trudel S et al. Second autologous stem cell transplantation as salvage therapy for multiple myeloma: impact on progression-free and overall survival. Biol Blood Marrow Transplant 2012; 18: 773–779.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    E Palfreyman, K Song & S Nantel

  2. Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada

    E Palfreyman, K Song & S Nantel

Authors
  1. E Palfreyman
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  2. K Song
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  3. S Nantel
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Correspondence to K Song.

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The authors declare no conflict of interest.

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Palfreyman, E., Song, K. & Nantel, S. Pseudo-autologous hematopoietic SCT as treatment for a patient with multiple myeloma who relapsed following an allogeneic hematopoietic SCT. Bone Marrow Transplant 48, 1138 (2013). https://doi.org/10.1038/bmt.2013.12

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