This report describes two infants with recurrent
pulmonary edema after umbilical cord blood
transplantation (CBT). A 3-month-old boy and a 7-month-old boy with infant
acute lymphoblastic leukemia underwent CBT from an unrelated donor in the first complete remission. The conditioning regimen consisted of
busulfan,
etoposide, and
cyclophosphamide.
Tacrolimus and short-term
methotrexate were administered for the prophylaxis of acute
graft-versus-host disease (GVHD). Neutrophil engraftment was achieved on days 17 and 19, respectively. Neither infant developed acute GVHD. They both exhibited
tachypnea and
weight gain on days 25 and 30, respectively, which were diagnosed as
pulmonary edema by chest X rays. The respiratory condition of the patients improved within a few days with the close monitoring of weight changes after the administration of
diuretics. However, they suddenly developed
dyspnea and
pulmonary edema again on days 37 and 59, respectively.
Steroid therapy was initiated for both patients. Their respiratory condition again improved quickly after the initiation of
steroid therapy. Their symptoms and clinical courses may be classified as a new entity of idiopathic
pneumonia syndrome (IPS). Therefore, these cases may represent a new unclassifiable IPS associated with either CBT or infants.