Acute tumor lysis syndrome in a patient with chronic myelogenous leukemia in blast crisis: role of high-dose Ara-C.

A patient with chronic myelogenous leukemia (CML) in lymphoid blast crisis developed acute tumor lysis syndrome following administration of high-dose busulfan, cyclophosphamide and cytarabine (Ara-C) in preparation for allogeneic bone marrow transplantation. Preconditioning cytoreduction, close monitoring and rapid institution of therapeutic measures were required to avoid renal failure and a fatal outcome. Acute tumor lysis syndrome has not been reported in marrow transplant patients receiving conventional preparative regimens as treatment for CML in blast crisis, and it is likely that its occurrence in this patient was precipitated by high-dose Ara-C.

Chimerism studies using in situ hybridization for the Y chromosome after T cell-depleted bone marrow transplantation.

In situ hybridization for the Y chromosome (Y-ISH) was used to monitor engraftment in 10 patients with hematological malignancies who had received T cell-depleted marrow transplants from sex-mismatched donors, seven of whom were only partially HLA-matched. In the three patients who engrafted, as the peripheral counts rose, the percentage of host peripheral blood and marrow mononuclear cells decreased steadily, although host cells (less than 1%) could still be detected as late as day 252. The percentage of host granulocytes fell rapidly to less than 0.2%. Seven patients did not achieve full engraftment by day 28. Those with a low percentage of host cells (less than 1%) improved with observation or treatment with steroids, while those with a high or increasing percentage of host cells did not improve even after treatment with GM-CSF or with repeat marrow infusion without reconditioning. In one patient with graft failure, the residual host cells were predominantly CD8+ CD57+ and CD3+ CD56+, phenotypes consistent with non-MHC-restricted cytotoxic T cells. Lack of full engraftment in recipients of T cell-depleted marrow is not always associated with autologous reconstitution and does not always require retransplantation. Y-ISH may be useful for monitoring patients at high risk for graft failure in order to detect adverse trends in mixed chimerism that will alter therapy early after transplantation.