[Kidney transplantation for end-stage renal disease after third allogeneic hematopoietic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia].

[Rinsho ketsueki] The Japanese journal of clinical hematology Pub Date : 2024-01-01 DOI:10.11406/rinketsu.65.7

Akihiko Nishijima, Naoki Shingai, Akihito Ohta, Kiyoko Suda, Kazuya Omoto, Shinya Ishida, Kosuke Yoshioka, Shuhei Kurosawa, Yutaro Hino, Yasushi Senoo, Aiko Igarashi, Gaku Oshikawa, Atsushi Hamamura, Takashi Toya, Hiroaki Shimizu, Yuho Najima, Takeshi Kobayashi, Kyoko Haraguchi, Yoshiki Okuyama, Kazuteru Ohashi, Noriko Doki

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Abstract

An 18-year-old man underwent allogenic bone marrow transplantation (BMT) for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). Ph+ALL relapsed 3 months after the first BMT, and the patient underwent a second BMT. However, Ph+ALL relapsed 4 months after the second BMT, and he received a haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) from his father. Molecular complete remission was confirmed 29 days after haplo-PBSCT. However, the patient needed dialysis for end-stage renal disease due to thrombotic microangiopathy 3 years and 2 months after haplo-PBSCT. He received a kidney transplantation from his father 7 years and 10 months after haplo-PBSCT, and got off dialysis after the kidney transplantation. Immunosuppressive therapy with methylprednisolone, tacrolimus, and mycophenolate mofetil was started for kidney transplantation, but the dose of immunosuppressive agents was reduced successfully without rejection soon after kidney transplantation. The patient has maintained long-term remission since the haplo-PBSCT, and his kidney function was restored by the kidney transplantation from his father.

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[费城染色体阳性急性淋巴细胞白血病第三次异基因造血干细胞移植后终末期肾病的肾移植]。

一名 18 岁男子因费城染色体阳性急性淋巴细胞白血病（Ph+ALL）接受了异基因骨髓移植（BMT）。第一次骨髓移植后 3 个月，Ph+ALL 复发，患者接受了第二次骨髓移植。然而，第二次 BMT 4 个月后，Ph+ALL 复发，他接受了来自父亲的单倍体外周血干细胞移植（haplo-PBSCT）。单倍体干细胞移植后29天，患者的分子完全缓解得到确认。然而，在单倍体干细胞移植3年零2个月后，患者因血栓性微血管病而需要透析治疗终末期肾病。他在单倍体-PBSCT 7 年零 10 个月后接受了父亲的肾移植，肾移植后停止了透析。肾移植时开始使用甲基强的松龙、他克莫司和霉酚酸酯进行免疫抑制治疗，但肾移植后不久就成功减少了免疫抑制剂的剂量，没有出现排斥反应。自单倍体骨髓造血干细胞移植后，患者的病情长期得到缓解，其父亲的肾移植也恢复了他的肾功能。

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[Rinsho ketsueki] The Japanese journal of clinical hematology

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