Patients undergoing immunosuppressive therapy have a 21% risk of developing Pneumocystis carinii pneumonia (PCP) if no prophylaxis is used [1]. During the first 6 months after bone marrow transplantation (BMT), the recipients have an estimated 9% risk of developing PCP [2]. Standard prophylaxis with sulfamethoxazole and trimethoprim (SMX/TMP) daily or intermittent doses has been used effectively in transplant and other immunosuppressed patients [2–4]. However, poor compliance and undesirable myelotoxicity are expected with this schedule, especially if other myelotoxic drugs such as ganciclovir have to be administered. Aerosolized pentamidine (AP) has been considered an attractive alternative in AIDS patients who do not tolerate SMX/TMP because only 4% of the patients discontinue AP prophylaxis due to side effects [5].

The cryopreservation procedure using a controlled-rate freezer can store hematopoietic stem cells and potentially, cause less damage to the cells.

A forty-year-old man underwent an allogeneic BMT from his HLA identical sister. GvHD prophylaxis was done with cyclosporine (CyA), methotrexate and prednisone (PDN). On day +90 extensive GvHD was noted and higher doses of immunosuppressive drugs alternating CyA with PDN were initiated. Patient's follow-up was complicated by intermittent episodes of leukopenia and monthly episodes of sinusitis or pneumonia. One year after BMT, the patient developed hoarseness and nasal voice. No etiologic agent could be identified on a biopsy sample of the vocal chord. Upon tapering the doses of immunosuppressive drugs, the patient had worsening of chronic GvHD and was reintroduced on high doses of cyclosporine alternating with prednisone on day +550. Three months later, GvHD remained out of control and the patient was started on azathioprine. On day +700, hoarseness and nasal voice recurred. Another biopsy of the left vocal chord failed to demonstrate infection. Episodes of sinusitis became more frequent and azathioprine was withheld 3 months after it was started. One month later, the patient had bloody nasal discharge and surgical drainage of maxillary sinuses was performed. Histopathology showed hyphae and cultures grew Scedosporium apiospermum. ltraconazole 800 mg/day was initiated. The patient developed progressive respiratory failure and died 15 days later.
Paciente portador de leucemia mielóide crônica, com irmã HLA-compatível foi submetido a transplante alogênico de medula óssea. No dia +90 pós-TMO foi diagnosticado doença do enxerto contra o hospedeiro (DECH) extensa e iniciado protocolo alternado de imunossupressão com altas doses de ciclosporina A e prednisona. O seguimento ambulatorial foi complicado, com granulocitopenia intermitente e quadros frequentes de sinusite e pneumonia. Um ano após o transplante, o paciente apresentou rouquidão e voz anasalada. Foi realizada uma biópsia de corda vocal mas nenhum agente infeccioso pode ser identificado. Na diminuição das doses das drogas imunossupressoras, houve piora da DECH crônica e foi reiniciado esquema de doses altas no dia +550. Três meses após, permanecendo o quadro de DECH fora do controle, foi tentado imunossupressão com azatioprina sem sucesso. Novo episódio de rouquidão foi observado no dia +700, mas nenhum agente pode ser identificado em nova biópsia de corda vocal. Após um mês, o paciente apresentou secreção nasal sanguinolenta e foi realizada uma raspagem cirúrgica dos seios maxilares. Scedosporium apiospermum foi identificado nas culturas iniciando-se itraconazol na dose de 800 mg/dia. O paciente desenvolveu falência respiratória progressiva e foi a óbito em 15 dias

Summary:The unrelated donor was mobilized with G-CSF at a dose of 5 g/kg × 5 days, and on day 6 post G-CSF, PBSC were harvested. A second pheresis was obtained (5.29 × 10 8 The Brazilian unrelated bone marrow donor program began in 1993 and an unrelated matched donor was TNC/kg and 1.59 × 10 6 CD34 + /kg) and cryopreserved as back-up (day 7). A total of 8.19 × 10 8 TNC/kg and found for a Fanconi anemia patient without a sibling match. An 11-year-old female recipient received FTBI 3.54 × 10 6 CD34 + cell/kg, was infused. Conditioning therapy consisted of FTBI (6.0 Gy) and CY 20 mg/kg × 2 days (6.0 Gy) and cyclophosphamide (40 mg/kg) as conditioning. The 41-year-old female unrelated donor received on an outpatient basis. No reaction was seen during PBSC infusion. GVHD prophylaxis consisted of CsA (1.5 mg/kg G-CSF at 5 g/kg × 5 days, and on day 6 and 7 postmobilization, peripheral blood stem cells were hartwice a day) plus short course MTX (1+, 3+, 6+) followed by 2.0 mg/kg of methylprednisolone (MP) on day 8+ postvested. Engraftment was seen on day 19 post-BMT and she remains alive and well on day 191+. This case supunrelated PBSC transplantation. The recipient developed acute skin GVHD (grade II) on ports the potential role of harvesting G-CSF-stimulated PBSC for unrelated bone marrow transplantation.day 16+. Engraftment data were as follows: ANC у 500/ l and platelets у 50 000/ l on days 19+ and 54+, respectKeywords: unrelated BMT; PBSC ively. The MP dose was increased up to 20 mg/kg/day and tapered off every 3 days with 2.5 mg/kg and then stopped after 19 days. Hypertension was seen during treatment with Unrelated bone marrow can be used for rescuing hematoposteroids. On day 30+ she presented with CMV antigenemia. iesis after ablative conditioning regimens. We report the Gancyclovir was started and the antigenemia resolved 3 feasibility of using G-CSF-stimulated peripheral blood stem days later. The patient developed limited chronic GVHD cells from an unrelated donor for a Fanconi anemia patient.of skin and liver (liver function test abnormalities) and she is on our current GVHD protocol of 2 years cyclosporine treatment. Cytogenetics on day 180+ were normal. She Case report remains well to date on day 191 post-unrelated bone marrow transplantation. An 11-year-old white girl diagnosed with severe aplastic anemia received CsA plus prednisone. Despite this treatment, the hemoglobin remained at 5.5 g/dl range and plateDiscussion lets 5000/ l. She had received few blood components at that time (less than 10).In 1995 she was referred to our BMT center and cytogenFanconi anemia is a rare disease associated with transformetics revealed Fanconi anemia. Because no HLA-matched ation to acute leukemia or SAA. The use of allogeneic bone sibling or other relatives were found, a search for an unremarrow transplantation can cure the disease. Unfortunately lated donor was initiated. Three months later a serologically only 25-30% of patients have an HLA-matched sibling matched HLA class I and class II donor was found in the don...