Successful Allogeneic Stem Cell Transplant for Philadelphia Chromosome Negative Acute Lymphoblastic Leukemia After Pneumonectomy for Pulmonary Mucormycosis: A Case Report and Review of the Literature.

Abstract

The incidence of relapsed Philadelphia chromosome-negative acute lymphoblastic leukemia in adults is estimated to be 40%-50%. Allogeneic stem cell transplantation can improve survival in relapsed acute lymphoblastic leukemia; however, impaired pulmonary function is detrimental for surviving the transplantation process. Here, we present a successful case of allogeneic transplantation for relapsed B-acute lymphoblastic leukemia after total resection of the left lung due to angioinvasive pulmonary mucormycosis. To our knowledge, this is the first successful case of allogeneic transplantation after total pneumonectomy. Specific considerations in this case included careful donor selection, judicious choice of pre-transplantation conditioning regimen, and utilizing novel immunotherapies to ensure major residual disease negativity prior to transplant. It is our hope that this case provides additional guidance to clinicians caring for patients with hematologic malignancies who develop invasive fungal infections and require major lung surgeries.