Resolution of Behcet's disease after non-myeloablative allogeneic stem cell transplant for acute myeloid leukaemia.

Resolution of Behcet's disease after non-myeloablative allogeneic stem cell transplant for acute myeloid leukaemia SIR, Behcet's disease (BD) commonly affects younger patients. The diagnosis is generally made from a cluster of symptomatol-ogies, including recurrent orogenital ulcers, skin rash, seronega-tive arthritis and uveitis. The diagnosis requires the presence of recurrent oral ulceration with two of four minor criteria that include anterior uveitis and papulopustular skin lesions. Although usually an indolent course, BD can result in life-threatening complications such as meningitis, stroke, pulmonary haemorrhage and thromboembolic disease. Anti-inflammatory drugs and immunosuppressive agents are the main therapeutics; in advanced BD, high-dose chemotherapy followed by autologous haemato-poietic stem cell transplants (HSCTs) resulted in some successes [1–3], indicating that immune ablation could modify the course of this disease. The lack of uniform successes, however, suggests that the reconstituted immune repertoires after autologous HSCT in some patients remain perturbed. Allogeneic HSCT that provides a new and diverse immune repertoire may, therefore, be more effective. However, literature on allogeneic HSCT in patients with BD is scanty. A patient whose BD relapsed after autologous HSCT successfully underwent an allogeneic HSCT and achieved a remission that lasted 2 yrs [4]. Resolution of BD also occurred in three patients who underwent umbilical cord blood transplants for myelodysplastic syndrome [5–7]. Unlike these previous cases that involved the use of myeloablative conditioning regimens, we report here the first case of BD that resolved following a non-myeloablative allogeneic HSCT for acute myeloid leukaemia (AML). A 43-yr-old Caucasian man presented in 2005 with a 3-to 4-yr history of recurrent oral ulcerations associated with a maculo-papular rash on the lateral aspect of his arms and back, an anterior uveitis and intermittent acute arthritis of his ankles and knees. Each acute episode lasted 6–8 weeks and occurred every 3–4 months. The symptoms worsened progressively. Autoimmune serological studies were negative. His HLA types were: HLA-A2, 11; B15, 55 and DRB1 0401, 1401. Based on the classification criteria set by the International Study Group [8], he was diagnosed with BD. Because his disease was limited, he was managed with NSAIDs. In March 2006, he presented with further oral ulcers. He was, on this occasion, also pancytopenic. Further investigations including a bone marrow examination led to a diagnosis of AML-M 0. Cytogenetics was normal. He received standard therapy with daunorubicin (60 mg/m 2 /day for 3 days) and ARA-C (200 mg/m 2 /day for 7 days) but did not …