A 57-year-old man underwent an autologous hematopoietic stem cell transplant for
mantle cell lymphoma in August 1999.
Anemia and
thrombocytopenia appeared in November 2001. He was diagnosed with further hematological examination as having
acute myeloid leukemia with multilineage dysplasia following secondary
myelodysplastic syndrome. He received the allogeneic hematopoietic stem cell transplant from his
HLA DRB1 locus mismatched brother in May 2002. The nonmyeloablative preparative regimen consisted of
fludarabine 30mg/m2 for 6 days and
busulfan 4mg/kg for 2 days.
Eosinophilia, decrease of lacrimal fluid and
liver dysfunction appeared on Day 104. We diagnosed this as chronic GVHD and treated the patient with
prednisolone 10 mg/day. Thereafter, his chronic GVHD gradually improved. He had
fever and
myalgia in the extremities and lumbar region with elevated serum CPK and
aldolase in January 2003. Histological examination led to a diagnosis of
polymyositis simultaneously with chronic GVHD.
Prednisolone 50 mg/day as an initial dose was started for the
polymyositis following which the
prednisolone dose was gradually tapered off. The
polymyositis improved promptly after the administration of
prednisolone and remains in remission with a current maintenance program of
prednisolone 5 mg/day.