Successful T-cell Replete Hematopoietic Stem Cell Boost Without Conditioning for Late Graft Failure

Area of Science:

• Hematology
• Immunology
• Transplantation

Background:

• Allogeneic stem cell transplantation (ASCT) is a curative therapy for hematologic malignancies.
• Late graft failure is a rare but serious ASCT complication, often associated with severe infections.
• Managing graft failure typically involves complex protocols and carries significant risks.

Observation:

• A patient experiencing late graft failure post-ASCT presented with persistent, severe infections.
• Standard treatments for graft failure and infection were ineffective.
• The patient's immunosuppression and nilotinib were discontinued to suppress host cells.

Findings:

• A T-cell replete hematopoietic stem cell boost without conditioning was administered.
• This intervention resulted in rapid donor engraftment.
• The patient achieved full donor chimerism, leading to the resolution of severe infections.

Implications:

• This case demonstrates the efficacy of a conditioning-free stem cell boost for late graft failure.
• Suppression of host cells via immunosuppressant and nilotinib withdrawal is crucial for successful boosting.
• This strategy offers a potentially safer and effective alternative for managing ASCT graft failure and associated infections.