SPONTANEOUS COMPLETE REMISSION AND RECOVERY OF DONOR HEMATOPOIESIS WITHOUT GVHD AFTER RELAPSE AND APPARENT MARROW GRAFT-REJECTION IN POOR-PROGNOSIS MYELODYSPLASTIC SYNDROME

We report a patient with poor-prognosis myelodysplastic syndrome (MDS) after successful treatment of lymphoma, who was given an allogeneic B MT, engrafted and achieved complete remission, but later had a relapse of his MDS with complete disappearance of donor haemopoiesis. After t wo episodes of CMV pneumonia and continued prophylactic use of gancicl ovir thereafter, he experienced a spontaneous complete disappearance o f all signs of MDS. including myelofibrosis, and a complete return to donor haemopoiesis. This case is the first one to suggest a graft-vers us-leukaemia effect (GVL) in MDS patients. It depicts the complex rela tionship between GVL, graft-versus-host disease (GVHD) and graft rejec tion. It could also constitute a clinical illustration of the possible antileukaemic effect of CMV infection and its treatment with ganciclo vir.