The transplantation of a large number of stem cells can overcome graft rejection but with the increased risk of GVHD. In this study, we analyzed the outcome of 32 adult patients with acquired severe aplastic anemia (SAA) who were at a high risk for graft rejection, including multiple transfusions (median 147 units, range 20-680) and long disease duration (median 67 months, range 3-347), and who had received both BM and CD34 þ -purified PBSCs from an HLA-matched sibling donor to reduce graft rejection. T cells in PBSCs were depleted using a magnetic-activated cell sorting method (CliniMACS system). Conditioning regimens consisted largely of CY and antithymocyte globulin (ATG) with fludarabine (FLU) or procarbazine (PCB). With a median follow-up of 89 months, the 8-year probability of survival was 87.5%. Neutrophils and plts promptly recovered, and none of the patients developed graft failure. The cumulative incidences of acute and chronic GVHD were 9.4 and 18.0%, respectively. Sustained engraftment and excellent survival without an apparent increase in the rate of GVHD in high-risk patients using the current approach showed that high-dose SCT with both BM and CD34 þ -purified PBSCs may yield better outcomes in heavily transfused and/or allo-immunized patients with SAA.

renal failure; pyoderma gangrenosum; spinal epidural abscess A 41-year-old Korean woman with end-stage renal failure secondary to diabetic nephropathy had been on maintenance haemodialysis for 12 years. She was admitted with high fever, and multiple erythematous Introduction ulcerated pustules of the skin on the lateral aspect of the right upper arm, lower back, left thigh, and both Pyoderma gangrenosum is an uncommon nonankles. Five days earlier rHuEpo has been administered contagious condition of unknown aetiology resembling by s.c. injection on the lateral aspect of the right upper a Shwartzman-like hypersensitivity reaction. It typicarm. One day after injection, high fever and multiple ally begins as a pustule and presents as solitary or erythematous macules and papules appeared at the site multiple sterile ulcerated nodules or plaques. The pusof injection and at other areas of the skin. On admistules may progress to large necrotic ulcerative lesions sion, the patient was alert, had a temperature of with painful undermined dusky margins [1 ]. Pyoderma 30.2°C, regular pulse (96/min), a blood pressure of gangrenosum may appear spontaneously or after 100/60 mmHg, and a respiration rate of 20/min. trauma to the skin. It may be associated with systemic Cardiopulmonary examination was unremarkable. diseases, e.g. Crohn's disease, ulcerative colitis, polyart-There was no lymphadenopathy, hepatosplenomegaly, eritis, or a variety of haematological disorders [2]. or arthralgia. The neurological examination was unre-Recently pyoderma gangrenosum has been reported markable. Laboratory investigations revealed WBC after administration of haematopoietic colony-14 000/mm3 (segment 88%), haemoglobin 7.4 g/dl, stimulating factors [3,4]. Although the exact mechanhaematocrit 23%, and platelets 50 000/mm3. Other ism involved remains uncertain, many findings point findings included BUN 25.8 mg/dl, creatinine to abnormal or depressed immune responses in patients 3.5 mg/dl, total protein 4.7 g/dl, albumin 3.0 g/dl. with pyoderma gangrenosum [5,6 ]. Fibrin degradation products and fibrinogen were Although infections and bacteraemia are common within the normal range. Repeated blood cultures and in haemodialysis patients, spinal epidural abscess swabs taken from the lesions remained negative. formation is rare. Infection of the epidural space is Septicaemia was suspected and cephalosporin and most frequently the result of haematogenous dissemgentamicin were administered. On the 3rd day, the ination from a distant focus [7 ], e.g. bacteraemia patient was afebrile and a skin biopsy was taken from secondary to infected arteriovenous graft or haemodiathe site of injection (Figure 1). It revealed acute necrotlysis catheter. Staphylococcus aureus was found in izing inflammation with perivasculitis in the subcutaneabout 60% of the cases. Early recognition and prompt ous tissue (Figure 2). The finding was consistent with treatment with antibiotics and decompressive laminecpyoderma gangrenosum. Sigmoidoscopy, barium tomy improve the otherwise ...