Unrelated bone marrow transplantation improves Crohn's disease in a patient with myelodysplastic syndrome that developed from aplastic anemia: A case report

Abstract

The present study describes the case of a 56-year-old male who was admitted to hospital due to pancytopenia. He was diagnosed as having acquired severe aplastic anemia (SAA). Immunosuppressive therapy with cyclosporine was transiently effective; however, the pancytopenia recurred. Bone marrow aspiration did not reveal an increased number of blasts, although it revealed trilineage dysplasia. Chromosomal analysis of the bone marrow demonstrated der(1;7) with abnormalities on chromosome 1. A diagnosis of a transformation from SAA to myelodysplastic syndrome (MDS) was made. High-grade fever and lower abdominal pain developed at approximately the same time. The patient was diagnosed as having Crohn's disease (CD). Treatment consisting of mesalazine and adalimumab was commenced. After two courses of azacitidine treatment, allogeneic bone marrow transplantation was performed, preceded by a reduced-intensity conditioning regimen, including fludarabine, cytarabine and cyclophosphamide. Tacrolimus and short-term methotrexate were used as prophylaxis against graft-versus-host disease. Chromosomal analysis of the bone marrow revealed a 100% donor-derived abnormal karyotype. The patient has since then remained in complete remission of both MDS and CD. On the whole, the present study demonstrates that allogeneic hematopoietic stem cell transplantation may be a promising treatment strategy for patients with combined MDS and CD. However, its use should be carefully considered.