Second allogeneic peripheral blood stem cell transplantation with fludarabine-based low-intensity conditioning regimen for relapsed myelodysplastic syndrome after allogeneic bone marrow transplantation

We describe the case of a 51-year-old patient with relapsed myelodysplastic syndrome after allogeneic bone marrow transplantation (BMT), who underwent allogeneic peripheral blood stem cell transplantation (PBSCT) after condit ioning with a novel regimen consisting of fludarabine, busulfan, and antith ymocyte globulin. The second PBSCT was performed early, at 3 months after t he initial allogeneic BMT, but it was well tolerated and complete hematolog ic remission was documented. The patient did not experience any early trans plantation-related organ toxicity but died from opportunistic infection 6 m onths after the second transplantation. Our experience suggests that this n ovel regimen may induce remission and could be offered to patients relapsin g after the first transplantation: however, the fludarabine-containing regi men might be accompanied by profound immunosuppression. (C) 2001 The Japane se Society of Hematology.