Acute cholecystitis after autologous bone marrow transplantation for acute myeloid leukemia

Background: We investigated the incidence of acute cholecystitisin patients with acute myeloid leukemia (AML) undergoing autologousbone marrow transplantation in complete remission. Patients and methods: Thirty-five consecutive acute myeloidleukemia patients were given oral busulfan4 mg/kg/day for 4days and IV cyclophosphamide 50 mg/kg/day for 4 days followedby reinfusion of autologous bone marrow purged with 4-hydroperoxycyclophosphamide. Results: Five of 35 patients developed clinical evidence ofacute cholecystitis, manifested by fever, nausea, vomiting,right-upper-quadrant pain, and abdominal guarding, within 18days after autologous bone marrow infusion.Ultrasonography andCT scans of the abdomen supported the diagnosis of cholecystitis.Three patients underwent cholecystectomy, while two patientswere treated medically; all recovered uneventfully. A reviewof 338 consecutive bone marrow transplant patients who underwentmarrow transplantation for a variety of diseases and were treatedwith other high-dose cytotoxic regimens during the same timeperiod revealed significantly fewer cases of cholecystitis,i.e. two, (p <0.0001). Conclusions: Five of 35 AML patients undergoing autologous bonemarrow transplant using busulfan, cyclophosphamide, and purgedbone marrow developed evidence of acute cholecystitis. Thesefindings suggest that the busulfan/cyclophosphamide preparativeregimen may be associated with acute cholecystitis. The trueincidence of this injury and its pathogenesis remain to be elucidated. acute myeloid leukemia, autologous bone marrow transplant, cholecystitis, busulfan, cyclophosphamide