Case 4:
A 19-year-old male with Ewing Sarcoma followed by treatment related MDS developed lung GVHD on day +451 after a MUD HSCT. GVHD therapy included sirolimus, prednisone, bortezomib, solumedrol, rituximab, and ECP. He responded well to bortezomib, allowing wean from prednisone (Table 1). He subsequently developed pancytopenia requiring bortezomib dose reduction and eventual discontinuation. The pancytopenia improved after discontinuation of bortezomib and he was able to remain steroid-free. He later developed a GVHD flare and was restarted on bortezomib along with prednisone, while remaining on sirolimus. Bortezomib was again discontinued due to pancytopenia and development of peripheral neuropathy. ECP was initiated with demonstrable initial respiratory response, but he subsequently experienced acute respiratory failure and succumbed to multi-organ failure.