Clinical Features and Treatment Outcomes of Hematopoietic Stem Cell Transplantation During 2006-2016 at a Single Institution in Miyazaki Prefecture

Background: The elucidation of clinical characteristics in deceased patients is essential to improve outcomes of hematopoietic stem cell transplantation（HSCT）for malignancy. Patients and Methods: We retrospectively examined 81 refractory／relapsed hematological malignancy patients treated with allogeneic HSCT（allo-HSCT）（54）and autologous HSCT（auto-HSCT）（27）in our hospital from 2006 to 2016. Results: Consistent with previous Japan Marrow Donor Program annual reports, the overall survival（OS）rate of allo-HSCT and auto-HSCT patients were 59% and 84% at five years, respectively. Among patients receiving allo-HSCT, severe regimen-related toxicity（RRT）（grade ≥ 3）events included cardiomyopathy due to cyclophospha-mide（1）, idiopathic pulmonary syndrome（1）, acute graft-versus-host disease（GVHD）Ⅲ-Ⅳ（3）, acute-exacer-bated chronic GVHD（2）, engraftment failure（2）, human herpesvirus-6 encephalitis（2）, and fungal infection（7）. Moreover, univariate analysis identified disease risk index（DRI）and non-CR status before allo-HSCT as prognostic factors of OS. Among patients receiving auto-HSCT, the severe RRT event was thrombotic microangiopathy （1）. The relapse after auto-HSCT in three patients with malignant lymphoma was a serious concern. Conclusion: Our study revealed critical issues in non-CR patients and those with high／very high DRI before allo-HSCT. Fur -thermore, the occurrence of severe RRT indicated the need for improvements in allo- and auto-HSCT. fusion gene. He achieved complete remission after multi-agent chemotherapy and received an unrelated CBT from a two HLA loci mismatched donor. The patient tested positive for antibodies (IgG) against HHV6 before conditioning for the CBT. The conditioning regimen consisted of total body irradiation (12 Gy) and high-dose cyclophosphamide (60 mg/ kg/day for 2 days). The number of infused nucleated cells in the cord blood was 2.1 × 10 7 /kg body weight. Prophylaxis for graft-versus-host disease (GVHD) consisted of a combination of tacrolimus (0.02 mg/kg/day) and mycophenolate mofetil (30 mg/kg/day). Prophylaxis for herpesvirus infection consisted of oral aciclovir (1,000 mg/day). Grade II acute GVHD of the skin developed on day 12 post-transplantation, and prednisolone (0.5 mg/kg/day) was administered. GVHD responded promptly, and prednisolone was discontinued by We report the case of a 45-year-old male patient who developed human herpesvirus 6 (HHV6)-associated pleurisy after an unrelated cord blood transplantation (CBT) for acute lymphoblastic leukemia. A large amount of pleural effusion accompanied by interstitial pneumonitis was noted on the right side on day 37 post-transplantation. A real-time quantitative PCR (RQ-PCR) assay revealed that the HHV6 viral load was substantially higher in the pleural effusion than in the peripheral blood plasma at the onset of pleurisy, with 2.2 × 10 2 and 7.9 × 10 3 copies of HHV6 DNA/mL in the peripheral blood plasma and the supernatant of the pleural effusion, respectively. Moreover, HHV6 DNA was still detected in the pleural effusion after antiviral therapy. Therefore, the pleural cavity may have been the primary site of HHV6 replication in the present case. To our knowledge, the present study is the first detailed report of adult HHV6-associated pleurisy after CBT. HHV6-associated pleurisy should be considered a potential complication when pleural effusion of unknown cause is encountered after CBT, even in the absence of HHV6 DNA in the peripheral blood. (Journal of Hematopoietic Cell Transplantation 3(2): 59-63, 2014. )