HLA半合致同種末梢血幹細胞移植後に発症したサイトメガロウイルス肝炎 合併移植片対宿主病に対してruxolitinibが奏効した骨髄異形成症候群の一例

Abstract

移植片対宿主病（graft-versus-host disease：GVHD）とサイトメガロウイルス（cytomegalovirus：CMV）感染症は造血幹 細胞移植後の主要な合併症で，しばしば難治化する．骨髄異形成症候群に罹患した48歳男性が化学療法とHLA半合致同種末 梢血幹細胞移植を実施後に肝障害をきたした．組織学的に肝臓GVHDとCMV肝炎の合併と診断し，ruxolitinibとgancyclovir により奏功を得た．CMV感染症を合併したステロイド抵抗性GVHDに対してもruxolitinibが有効な可能性がある．

A 48-year-old man with high-risk myelodysplastic syndrome underwent peripheral blood stem cell transplantation from HLA haploidentical sister with post transplantation cyclophosphamide. He developed liver dysfunction around 4 months after transplant. Transjagler liver biopsy revealed liver acute graft-versus-host disease (GVHD) ,which was complicated with cytomegalovirus (CMV) hepatitis. GVHD was refractory to corticosteroid; thus, we administered ruxolitinib concomitant with ganciclovir, which resulted in the improvement of both GVHD and CMV hepatitis. Ruxolitinib was effective for steroid refractory GVHD, and may be safely administered to patients with GVHD complicated with CMV infection.