Autologous bone marrow transplant in a patient with sickle cell disease and diffuse large B-cell lymphoma

• Published in: Transplantation proceedings 2003-12, Vol.35 (8), p.3089-3092
• Main Authors: Onitilo, A.A, Lazarchick, J, Brunson, C.Y, Frei-Lahr, D, Stuart, R.K
• Format: Article
• Language: English
• Subjects: Adult; Anemia, Sickle Cell - complications; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Biopsy; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Female; Humans; Lymph Node Excision; Lymph Nodes - pathology; Lymphoma, B-Cell - complications; Lymphoma, B-Cell - drug therapy; Lymphoma, B-Cell - surgery; Lymphoma, Large B-Cell, Diffuse - complications; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - surgery; Medical sciences; Neoplasm Staging; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Autologous; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2003.10.085

As the life expectancy of patients with homozygous sickle cell anemia (SCA) improves, SCA care providers are confronted with diseases of the adult SCA population rarely seen before. We report here a 40-year-old woman with SCA who developed diffuse large B-cell non-Hodgkin's lymphoma (NHL) that was treated with eight cycles of chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide (CHOPE), without complete remission. She subsequently underwent high-dose cyclophosphamide and total-body irradiation followed by autologous bone marrow transplantation (BMT). To reduce the risk of sickle cell crisis precipitated by G-CSF, she underwent hypertransfusion to maintain a low % hemoglobin S throughout her treatment course. Although she has required iron chelation therapy and shows no sign of modification of her underlying SCA, she remains in remission from NHL 12 years posttransplant. To our knowledge, this is the first reported case of autologous BMT in a patient with SCA. Our patient illustrates that SCA in itself does not preclude autologous stem cell transplantation for lymphoma in selected patients, and this report should encourage others to consider autologous BMT in adults with SCA where it represents a lifesaving therapy for malignant diseases.