Severe oesophagitis after allogeneic bone marrow transplantation for Fanconi's anemia

Allogeneic bone marrow transplantation (BMT) is an effective treatment for Fanconi's anemia (FA) but it requires a dose reduction of alkylating agents used for conditioning because of the increased sensitivity of FA cells to DNA cross-linking agents. Oesophageal damage has not previously been descri bed as a complication after allogeneic BMT for this indication. We report f ive cases of severe oesophagitis with stenosis in patients transplanted for FA, It occurred either early, or more surprisingly, several years after BM T and could have easily been misdiagnosed. It could be explained by hyperse nsitivity of the FA mucosal cells to cytotoxic agents despite the reduced d oses of cyclophosphamide and irradiation or to non diagnosed congenital abn ormalities of the oesophagogastric junction. However, the evolution of the oesophageal disease was favorable in all, and none of the patients develope d secondary cancer. Awareness of this complication will lead to earlier dia gnosis and treatment of oesophageal stenosis and related malnutrition.