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Allogeneic bone marrow and peripheral stem cell transplantation from a haplo-identical mother and CD34 positive
1Division of Hematology/Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Japan.
Insights
CD34-positive cell selection in HLA-mismatched transplants may prevent graft-versus-host disease (GVHD). This approach was used in a pediatric CML patient, but relapse occurred post-transplant.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- A pediatric patient with chronic myeloid leukemia (CML) in blastic crisis underwent a stem cell transplant.
- The transplant utilized bone marrow (BM) and peripheral blood stem cells (PBSC) from an HLA-mismatched mother, with CD34-positive selection.
Observation:
- The patient received preconditioning with thiotepa, cyclophosphamide, rabbit anti-thymocyte globulin, and total body irradiation (TBI).
- Engraftment was confirmed, and no graft-versus-host disease (GVHD) was observed initially.
Findings:
- The patient relapsed on day 50 post-transplant and unfortunately died despite donor lymphocyte infusions.
- The study suggests CD34-positive cell selection might mitigate severe acute GVHD in HLA-mismatched stem cell transplantation.
Implications:
- CD34-positive selection is a potential strategy to reduce GVHD in unrelated or mismatched stem cell transplants.
- Further research is needed to optimize this technique and address relapse post-transplant in CML patients.
Abstract:
A 6-year-old boy with CML in blastic crisis was transplanted with BM and PBSC from his HLA-mismatched MLC-positive mother following CD34-positive selection. Preconditioning for transplant was with thiotepa, cyclophosphamide, rabbit anti-human thymocyte globulin, and TBI followed by infusion of 2.6 x 10(6)/kg of CD34-positive BM and PBSC. Engraftment was confirmed by FISH analysis, and GVHD was not observed. On day 50, he relapsed and died despite three transfusions of donor lymphocytes without GVHD prophylaxis. CD34-positive cell selection for HLA-mismatched transplantation may prevent severe acute GVHD.