Clin Pediatr Hematol Oncol.  2016 Apr;23(1):57-60. 10.15264/cpho.2016.23.1.57.

Successful Allogeneic Hematopoietic Stem Cell Transplantation for a Patient with Very Severe Aplastic Anemia During Active Invasive Fungal Infection

• Seo E
• Kim H
• Koh KN
• Im HJ
• Seo JJ

• KMID: 2168910
• DOI: http://doi.org/10.15264/cpho.2016.23.1.57

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) may not be considered feasible in a patient with active fungal infection due to transplant-related mortality. We report a case of HSCT performed on a 6-month-old girl, who was diagnosed with very severe aplastic anemia (vSAA) at the age of 2 months, during active invasive pulmonary aspergillosis (IPA). Despite receiving continuous antifungal treatment and multiple granulocyte infusions, her IPA was aggravated. She underwent allogeneic HSCT from a matched sibling donor using conditioning regimen of fludarabine, reduced dose of cyclophosphamide, and anti-thymocyte globulin (ATG) during IPA. After neutrophil engraftment, fever subsided and IPA improved. She was continued on voriconazole for 7 months after HSCT. She is alive with normal hematopoiesis 4 years post-transplant. Our report suggests that allogeneic HSCT using conditioning regimen of fludarabine, reduced dose of cyclophosphamide, and ATG can be a feasible option for the patients with vSAA even during active fungal infection.

Keyword

Aplastic anemia; Hematopoietic stem cell transplantation; Invasive pulmonary aspergillosis

MeSH Terms

Anemia, Aplastic*
Antilymphocyte Serum
Cyclophosphamide
Female
Fever
Granulocytes
Hematopoiesis
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Infant
Invasive Pulmonary Aspergillosis
Mortality
Neutrophils
Siblings
Tissue Donors
Antilymphocyte Serum
Cyclophosphamide