{Reference Type}: Case Reports
{Title}: Successful treatment with matched unrelated donor peripheral blood stem cell transplantation for very severe aplastic anemia in presence of active infections: A case report.
{Author}: Huang YR;Xie CQ;Tong JF;Zhang XH;Xu Y;Yuan XG;
{Journal}: Medicine (Baltimore)
{Volume}: 99
{Issue}: 14
{Year}: Apr 2020
{Factor}: 1.817
{DOI}: 10.1097/MD.0000000000019807
{Abstract}: <B>BACKGROUND: </B>Very severe aplastic anemia (vSAA) with active infections is always fatal. Adequate infection control before hematopoietic stem cell transplantation is recommended.<BR><B>METHODS: </B>A 38-year-old woman with vSAA suffered from acute perforated appendicitis and invasive pulmonary fungal infection, and she failed to respond to intense antimicrobial therapies.<BR><B>METHODS: </B>She was diagnosed with refractory vSAA with stubborn acute perforated appendicitis and invasive pulmonary fungal infection.<BR><B>METHODS: </B>We successfully completed an emergent reduced intensity conditioning-matched unrelated donor (MUD)-peripheral blood stem cell transplantation (PBSCT) as a salvage therapy in the presence of active infections. The conditioning regimens consisted of reduced cyclophosphamide 30 mg/kg/day from day-5 to day-3, fludarabine 30 mg/m/day from day-5 to day-3 and porcine-antilymphocyte immunoglobulin 15 mg/kg/day from day-4 to day-2 without total body irradiation. Cyclosporin A, mycophenolate mofetil and short-term methotrexate were administered as graft-versus-host disease (GVHD) prophylaxis. Neutrophils and platelets were engrafted on day+15 and day+21. Appendiceal abscess and severe pneumonia developed after neutrophil engraftment, which were successfully managed with intense antimicrobial therapy and surgical intervention.<BR><B>RESULTS: </B>Only limited cutaneous chronic GVHD was observed 5 months after transplantation. The patient still lives in a good quality of life 2 years after transplantation.<BR><B>CONCLUSIONS: </B>Active infections may be no longer a contraindication to hematopoietic stem cell transplantation for some patients with vSAA.