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A 66-year-old man with fever was diagnosed with B-cell acute lymphoblastic leukemia. He failed to achieve complete remission after initial hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD) therapy and was referred to our hospital to undergo allogeneic stem cell transplantation. Bone marrow aspiration showed 97.5% lymphoblasts positive for CD19. Blood tests revealed the presence of broad antihuman leukocyte antigen (HLA) antibodies. After blinatumomab therapy, bone marrow aspiration showed 19.6% blasts. Furthermore, after additional mini-mitoxantrone, etoposide, and cytarabine (mini MEC) therapy, the patient achieved complete remission. Interestingly, after blinatumomab therapy, the blood tests revealed that the titers of anti-HLA antibodies had decreased, and cord blood transplantation was performed in complete remission. This case report revealed that chemotherapy including blinatumomab, which targets CD19-positive cells, has the potential to decrease antibody-producing cells, thus leading to a dramatic reduction of anti-HLA antibodies.

A 46-year-old female patient underwent a cord blood transplantation (conditioning regimen: fludarabine/busulfan4/melphalan80; graft-versus-host disease (GVHD) prophylaxis: tacrolimus + mycophenolate mofetil) for acute myeloid leukemia (AML) with her 1st hematological complete response to induction therapy (idarubicin 3 days+cytarabine 7 days). She lost her consciousness due to human herpesvirus 6 (HHV-6) encephalitis on day 31, and therefore, we increased the foscarnet dosage (from 120 mg/kg to 180 mg/kg). Her consciousness level improved after treatment. However, 8 hours of sudden hypothermia occurred with hyperhidrosis, hypertension, and subsequent hyperglycemia on day 34. Her condition did not improve even after administration of anticonvulsant, steroid pulse, or intravenous immunoglobulin. A total of 75 attacks were observed until she was discharged on day 471. She has not shown chronic GVHD or relapsed AML since then. However, HHV-6 caused prolonged damage to her hypothalamus as observed through magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) using