Stem Cell Transplantation for Concomitant MS and Acute Myelogenous Leukemia (AML).

TitleStem Cell Transplantation for Concomitant MS and Acute Myelogenous Leukemia (AML).
Publication TypeJournal Article
AuthorsBrown TR, Kraft GH, Bowen JD
JournalInternational Journal of MS Care

A 66-year-old Caucasian female developed numbness in her hands and left foot drop beginning in 1982 and slowly progressing over the next ten years. She was diagnosed in 1992 with primary-progressive MS based on worsening neurological symptoms without ever having exacerbations, abnormal brain MRI, cervical MRI and CSF. She was treated symptomatically until 1999, when she entered the PROMISE drug trial and was randomized to the active arm of the study, taking glatiramer acetate (GA). In 1999, she was also diagnosed with T1c M0 infiltrating ductal carcinoma of the right breast. She received an excisional biopsy and 47Gy of radiation therapy. When the PROMISE study ended she continued on GA. In September 2002, she presented with uterine bleeding, fatigue and pancytopenia. She had a bone marrow biopsy yielding a diagnosis of AML, stage M2. GA was stopped. She underwent induction with cytarabine 100 mg/m2/day x 7 days + daunorubicin 45mg/m2/day x 3 days and consolidation with four cycles of cytarabine. Because of worsening fatigue, she had a repeat bone marrow biopsy with flow cytometry showing evidence of AML relapse in September 2003. Two months later, she underwent autologous stem cell transplantation with peripheral blood cells that had been harvested after the second cycle of consolidation therapy. She was conditioned with busulfan 1mg/kg x16 doses and etoposide 60mg/kg x 1 dose. Stem cell transplantations are gaining wider use in heme-oncology. They have been reported as treatment for MS since 1997 and for concomitant MS and leukemia since 1999. No MS patient would like to develop a lifethreatening malignancy. However, when such an event occurs, stem cell transplants offer a ray of hope for controlling both MS and the coexisting cancer. For this patient, no further disease modifying treatment of MS is planned. Evaluation and follow-up data will be presented.

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