Fetal liver transplantation in aplastic anemia and leukemia

This study reviews results of fetal liver transplantation in hematologic disorders including aplastic anemia, leukemia and thalassemia. One hundred and twenty two patients received transplants for aplastic anemia; engraftment was reported in 4 patients; graft-versus-host disease (GvHD) did not occur. Complete and partial responses were reported in one-half of patients, the majority of whom had no evidence of engraftment. Thirty-nine patients received transplants for leukemia. Transient engraftment was reported in 40% and two developed GvHD; survival extended to more than 2 years. The higher rate of engraftment in patients with leukemia suggests a role of pretransplant immune suppression. The risk of GvHD appears to be low despite complete HLA-mismatching. These data suggest a possible role for fetal liver transplantation in man. Future studies should probably be based on preclinical data obtained in large animal models.