BONE-MARROW NECROSIS IN A PATIENT WITH ACUTE MYELOBLASTIC-LEUKEMIA DURING ADMINISTRATION OF G-CSF AND RAPID HEMATOLOGIC RECOVERY AFTER ALLOTRANSPLANTATION OF PERIPHERAL-BLOOD STEM-CELLS

Allogeneic peripheral blood stem cell transplantation from an HLA-iden tical sibling was performed for a 38-year-old male with refractory acu te myeloblastic leukemia, The patient was conditioned with total body irradiation (TBI) and high-dose cytosine arabinoside (Ara-C), G-CSF (3 00 mu g/body) was started for priming of residual leukemic cells 24 hr before the beginning of TBI (day -9), However, intolerable generalized bone pain appeared shortly after the start of first dose of G-CSF, an d persisted for 3 days in spite of the cessation of G-CSF, Posttranspl ant hematopoietic engraftment was very rapid, Bone marrow biopsy speci mens on day 14 and 30 showed typical bone marrow necrosis histological ly. This is the first case of bone marrow necrosis during administrati on of G-CSF, and our experience suggests that PBSC could repopulate he matopoiesis in spite of severe bone marrow necrosis. (C) 1998 Wiley-Li ss, Inc.