[Intensive multi-drug chemotherapy for acute myeloid leukemia in a renal allograft recipient]

A Fifty-two year old male, who had received a renal transplantation from his sibling 14 years previously, was referred to our hospital because of leukocytosis, anemia and thrombocytopenia. A bone marrow examination revealed an increase of leukemic blasts with morphological dysplasia of mature hematopoietic cells. The diagnosis of acute myeloid leukemia (AML) with multilineage dysplasia without antecedent myelodysplastic syndrome was made. Since the patient's general condition and the function of the transplanted kidney were well maintained, intensive therapy for his AML was chosen. The dosage of the immune suppressive reagents that were administered to prevent the rejection of the transplanted kidney were reduced during chemotherapy to minimize the adverse effect of immune suppression, and G-CSF was administrated to shorten the neutropenic period. Along with these supportive strategies, cytosine arabinoside and idarubicin-based induction therapy followed by four courses of intensive consolidation therapy were successfully performed without disturbing his renal function. It is suggested that intensive chemotherapy is feasible for post-transplant AML patients when their general condition and transplanted renal functions are well maintained.