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International Journal of Hematology

, Volume 80, Issue 5, pp 449–452 | Cite as

Unmanipulated Reduced-Intensity Stem Cell Transplantation from a Haploidentical Donor Mismatched at 3 HLA Antigens to a Patient with Leukemic Transformation of Myelodysplastic Syndrome: Successful Second Transplantation after Graft Rejection

  • Eui Ho Kim
  • Kazuhiro Ikegame
  • Manabu Kawakami
  • Sumiyuki Nishida
  • Tatsuya Fujioka
  • Yuki Taniguchi
  • Tomoki Masuda
  • Yoshihiro Oka
  • Ichiro Kawase
  • Hiroyasu Ogawa
Case Report

Abstract

We present the case of a patient with myelodysplastic syndrome who experienced leukemia transformation and subsequently underwent transplantation of unmanipulated peripheral blood stem cells from a haploidentical sibling mismatched at 3 HLA antigens, along with a reduced-intensity regimen (fludarabine, busulfan, and anti-T-lymphocyte globulin) and tacrolimus-containing graft-versus-host disease (GVHD) prophylaxis. The patient experienced graft rejection but successfully underwent a second transplantation from the same donor with a slightly intensified conditioning regimen. Although the patient developed life-threatening cytomegalovirus (CMV) pneumonia following the second transplantation, he recovered completely from the pneumonia with intensive supportive therapy. He is still in complete remission past day 1000 in the absence of GVHD. As far as we know, this report is the first to describe a successful second transplantation that was performed for graft rejection following HLA-haploidentical nonmyeloablative stem cell transplantation. Furthermore, we emphasize that patients should be carefully monitored for CMV infection when reduced-intensity conditioning is given repeatedly over a short period.

Key words

Reduced-intensity stem cell transplantation HLA-haploidentical stem cell transplantation Graft rejection Second transplantation 

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References

  1. 1.
    Georges GE, Storb R, Thompson JD, et al. Adoptive immunother- apy in canine mixed chimeras after nonmyeloablative hematopoietic cell transplantation. Blood. 2000;95:3262–3269.PubMedGoogle Scholar
  2. 2.
    Giralt S, Estey E, Albitar M, et al. Engraftment of allogeneic hematopoietic progenitor cells with purine analog-containing chemotherapy: harnessing graft-versus-leukemia without myeloablative therapy. Blood. 1997;89:4531–4536.PubMedGoogle Scholar
  3. 3.
    Slavin S, Nagler A, Naparstek E, et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases. Blood. 1998;91:756–763.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Niederwieser D, Maris M, Shizuru JA, et al. Low-dose total body irradiation (TBI) and fludarabine followed by hematopoietic cell transplantation (HCT) from HLA-matched or mismatched unrelated donors and postgrafting immunosuppression with cyclo-sporine and mycophenolate mofetil (MMF) can induce durable complete chimerism and sustained remissions in patients with hematological diseases. Blood. 2003;101:1620–1629.CrossRefPubMedGoogle Scholar
  5. 5.
    Bornhauser M, Thiede C, Platzbecker U, et al. Dose-reduced conditioning and allogeneic hematopoietic stem cell transplantation from unrelated donors in 42 patients. Clin Cancer Res. 2001;7:2254–2262.PubMedGoogle Scholar
  6. 6.
    Sykes M, Preffer F, McAfee S, et al. Mixed lymphohaemopoietic chimerism and graft-versus-lymphoma effects after non-myeloablative therapy and HLA-mismatched bone-marrow transplantation. Lancet. 1999;353:1755–1759.CrossRefPubMedGoogle Scholar
  7. 7.
    O’Donnell PV, Luznik L, Jones RJ, et al. Nonmyeloablative bone marrow transplantation from partially HLA-mismatched related donors using posttransplantation cyclophosphamide. Biol Blood Marrow Transplant. 2002;8:377–386.CrossRefPubMedGoogle Scholar
  8. 8.
    Tamaki H, Ikegame K, Kawakami M, et al. Successful engraftment of HLA-haploidentical related transplants using nonmyeloablative conditioning with fludarabine, busulfan and anti-T-lymphocyte globulin. Leukemia. 2003;17:2052–2054.CrossRefPubMedGoogle Scholar
  9. 9.
    van Rood JJ, Loberiza FR Jr, Zhang MJ, et al. Effect of tolerance to noninherited maternal antigens on the occurrence of graft- versus-host disease after bone marrow transplantation from a parent or an HLA-haploidentical sibling. Blood. 2002;99:1572–1577.CrossRefPubMedGoogle Scholar
  10. 10.
    Eizuru Y, Minematsu T, Minamishima Y, et al. Rapid diagnosis of cytomegalovirus infections by direct immunoperoxidase staining with human monoclonal antibody against an immediate-early antigen. Microbiol Immunol. 1991;35:1015–1022.CrossRefPubMedGoogle Scholar
  11. 11.
    Kraus AB, Shaffer J, Toh HC, et al. Early host CD8 T-cell recovery and sensitized anti-donor interleukin-2-producing and cytotoxic T-cell responses associated with marrow graft rejection following nonmyeloablative allogeneic bone marrow transplantation. Exp Hematol. 2003;31:609–621.CrossRefPubMedGoogle Scholar
  12. 12.
    Spitzer TR, McAfee SL, Dey BR, et al. Nonmyeloablative haploidentical stem-cell transplantation using anti-CD2 monoclonal antibody (MEDI-507)-based conditioning for refractory hematologic malignancies. Transplantation. 2003;75:1748–1751.CrossRefPubMedGoogle Scholar
  13. 13.
    Kottaridis PD, Milligan DW, Chopra R, et al. In vivo CAMPATH-1H prevents graft-versus-host disease following nonmyeloablative stem cell transplantation. Blood. 2000;96:2419–2425.PubMedGoogle Scholar
  14. 14.
    Nash RA, Pepe MS, Storb R, et al. Acute graft-versus-host disease: analysis of risk factors after allogeneic marrow transplantation and prophylaxis with cyclosporine and methotrexate. Blood. 1992;80:1838–1845.PubMedGoogle Scholar
  15. 15.
    Deeg HJ, Spitzer TR, Cottler-Fox M, Cahill R, Pickle LW. Conditioning- related toxicity and acute graft-versus-host disease in patients given methotrexate/cyclosporine prophylaxis. Bone Marrow Transplant. 1991;7:193–198.PubMedGoogle Scholar
  16. 16.
    Ferrara JL, Levy R, Chao NJ. Pathophysiologic mechanisms of acute graft-vs.-host disease. Biol Blood Marrow Transplant. 1999;5:347–356.CrossRefPubMedGoogle Scholar
  17. 17.
    Ichinohe T, Maruya E, Saji H. Long-term feto-maternal micro- chimerism: nature’s hidden clue for alternative donor hematopoietic cell transplantation? Int J Hematol. 2002;76:229–237.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2004

Authors and Affiliations

  • Eui Ho Kim
    • 1
  • Kazuhiro Ikegame
    • 1
  • Manabu Kawakami
    • 1
  • Sumiyuki Nishida
    • 1
  • Tatsuya Fujioka
    • 1
  • Yuki Taniguchi
    • 1
  • Tomoki Masuda
    • 1
  • Yoshihiro Oka
    • 1
  • Ichiro Kawase
    • 1
  • Hiroyasu Ogawa
    • 1
  1. 1.Department of Molecular MedicineOsaka University Graduate School of MedicineOsakaJapan

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