We present the case of a 53-year-old woman with prefibrotic stage primary myelofibrosis (PMF) who underwent cord blood transplantation. Nine years after transplantation, she relapsed, which was confirmed by a bone marrow examination. We decided to treat her using azacitidine. After three courses of azacitidine, a partial cytogenetic response was confirmed. Azacitidine maintenance therapy successfully maintained a low level of recipient-origin peripheral blood cells with a stable hematological condition. Azacitidine may therefore be a promising therapeutic option for PMF patients who relapse after allogeneic stem cell transplantation.

Background Toxoplasmosis is a rare but life‐threatening infection occurring in immunocompromised hosts, including allogeneic hematopoietic stem cell transplantation (allo‐HSCT) recipients. However, thus far, the clinical features and incidence of toxoplasmosis in autologous HSCT (auto‐HSCT) recipients remain unknown. This retrospective survey aimed to analyze 152 patients who received auto‐HSCT between 1998 and 2017. Methods Serological tests for Toxoplasma gondii‐specific IgG were performed on 109 (71.7%) recipients, and 12 pre‐HSCT recipients (11%) were Toxoplasma seropositive. Among the 12 recipients, three who did not receive trimethoprim‐sulfamethoxazole (TMP/SMX) prophylaxis developed cerebral, pulmonary or disseminated toxoplasmosis due to reactivation after auto‐HSCT and died despite treatment. Results The incidences of toxoplasmosis were 2% and 25% among 152 auto‐HSCT recipients (five recipients received auto‐HSCT two times) and 12 pre‐HSCT Toxoplasma seropositive recipients, respectively. Further, we conducted a literature review and identified 21 cases of toxoplasmosis following auto‐HSCT. In these previous cases, the mortality rate was high, especially for pulmonary and disseminated toxoplasmosis. Our findings suggest that, similar to toxoplasmosis after allo‐HSCT, toxoplasmosis after auto‐HSCT is a fatal complication. Conclusions Serial screening of T. gondii‐specific IgG before HSCT could contribute to the detection of Toxoplasma reactivation and allow for prompt diagnosis and treatment. The present study is the first to reveal the incidence of toxoplasmosis after auto‐HSCT among seropositive patients in Japan.

A 51-year-old woman with Philadelphia chromosome-positive acute lymphoblastic leukemia underwent a second cord blood transplantation followed by maintenance therapy with interferon-α. After 33 months, she developed cardiogenic shock caused by advanced atrioventricular block. Laboratory tests revealed increased myocardium enzymes, and ultrasonic cardiography demonstrated mild thickening of the left ventricular wall. She was diagnosed with myocarditis and successfully treated using prednisolone. Myocarditis after allogeneic stem cell transplantation is a rare but potentially fatal complication. However, it is important for physicians to be aware of this complication because all of the symptoms may be reversed with immunosuppressive treatment.

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