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Recombinant human G-CSF-mobilized peripheral blood stem cells for second allogeneic transplant after bone marrow
M Zecca1, C Perotti, P Marradi
1Department of Paediatrics, University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy.
Insights
Peripheral blood stem cell (PBSC) transplants using granulocyte-colony stimulating factor (G-CSF) offer a viable solution for pediatric patients experiencing graft failure after initial bone marrow transplants. These G-CSF mobilized PBSC procedures were well-tolerated and successful in two children.
Area of Science:
- Hematology
- Pediatric Oncology
- Transplantation Immunology
Background:
- Allogeneic bone marrow transplantation (BMT) is a standard treatment for severe pediatric hematologic disorders.
- Graft failure can occur after initial BMT, necessitating alternative therapeutic strategies.
- Human leukocyte antigen (HLA) matching is crucial for successful allogeneic transplantation.
Observation:
- Two pediatric patients with severe aplastic anemia and sickle cell anemia experienced graft failure after initial allogeneic BMT.
- A second transplant using granulocyte-colony stimulating factor (G-CSF) mobilized peripheral blood stem cells (PBSC) was performed in both cases.
- Donors for the second transplant included an HLA-haploidentical mother and the previously used HLA-identical sibling.
Findings:
- G-CSF and PBSC collection were well-tolerated by both pediatric patients.
- Successful engraftment of donor hematopoiesis was achieved in both cases.
- Severe graft-versus-host disease was not observed in either patient post-transplant.
Implications:
- PBSC transplantation using G-CSF mobilization is a feasible and effective treatment option for reversing graft failure in pediatric patients.
- This approach expands therapeutic options for children with hematologic malignancies and bone marrow failure syndromes.
- HLA-haploidentical PBSC transplantation can be a successful alternative when HLA-matched donors are unavailable or previous grafts have failed.
Abstract:
Two children affected by severe aplastic anaemia and sickle cell anaemia rejected the allogeneic bone marrow transplantation from an HLA-matched unrelated volunteer and an HLA-identical sibling, respectively. In both cases a second transplant using granulocyte-colony stimulating factor (G-CSF) mobilized peripheral blood stem cells (PBSC) was performed. Donors were the HLA-haploidentical mother and the same HLA-identical sibling who was employed for the first marrow allograft, respectively. Treatment with G-CSF and PBSC collection were well tolerated. Both patients had engraftment of donor haemopoiesis and did not experience severe graft-versus-host disease. These cases confirm that PBSC transplant should be considered as a feasible treatment to reverse graft failure in paediatric patients.