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The majority of patients with relapsed or refractory Hodgkin's lymphoma (HL) will not be cured with standard therapy. Relapse rates remain high even after autologous stem cell transplantation (SCT), particularly for patients with high-risk disease. Allogeneic SCT offers several potential advantages for patients with HL. It is feasible when autologous stem cells are not available and stem cell grafts will be tumor free. Perhaps a more important advantage is the potential to generate a graft-versus-Hodgkin's lymphoma (GVHL) effect. Unfortunately, although allogeneic SCT may cure some HL patients, treatment-related mortality has been unusually high, and superior survival, when compared to autologous SCT, has not been demonstrated. Nonmyeloablative conditioning and allogeneic SCT may induce a direct GVHL reaction with less conditioning regimen-related toxicity and ultimately may have the potential to improve cure rates and survival for advanced HL patients.

症例は71歳の男性. 血痰のために近医を受診し右下肺野に空洞を伴う異常陰影を指摘され, 当院に紹介入院となった. 肺癌と診断し右下葉切除術を行い, 術中に赤血球濃厚液を6単位, 新鮮凍結血漿を10単位輸血した. 経過は順調であったが, 術後11日目に発熱が始まり, 13日目に全身紅斑が出現し, 汎血球減少, 下痢, 肝腎不全, 敗血症を併発し, 23日目に死亡した. 臨床経過並びに低形成を示した骨髄生検所見などから輸血後GVHD様症候群と考えられた. 輸血後GVHD様症候群は発症すれば致死率が高く, 輸血前血液照射などの発症予防を構ずることが大切であることを示唆する症例であった. また文献上, 我々の検索した範囲で肺切除後に発症した輸血後GVHD様症候群の報告はみられず, 本症例が1例目と思われる.

Myelodysplastic syndrome (MDS) is a stem cell disorder, and hematopoietic stem cell transplantation is currently the only therapeutic modality that is potentially curative. Among patients with less advanced MDS (5% marrow blasts), 3-year survivals of 65-70% are achievable with HLA-identical related and HLA-matched unrelated donors. The overall probability of disease recurrence in these patients is5%. Among patients with advanced disease (/=5% marrow blasts), about 35-45% and 25-30%, respectively, are surviving in remission after transplantation from a related or from an unrelated donor; the incidence of post-transplant relapse is 10-35%. The criteria proposed by the International Prognostic Scoring System (IPSS) derived from non-transplanted patients, also predict survival following transplantation. The development of new conditioning regimens has permitted successful hematopoietic stem cell transplants even in patients more than 60 years of age. Improved survival with transplants from unrelated volunteer donors may, in part, reflect selection of donors on the basis of high resolution (allele-level) HLA typing. Autologous stem cell transplantation may be beneficial for selected patients who have obtained a complete remission with conventional chemotherapy. Treatment-related morbidity and mortality, in particular after allogeneic transplantation, remain challenges that need to be addressed with innovative approaches.