Successful hematopoietic stem cell transplantation from an HLA-mismatched parent for engraftment failure after unrelated cord blood transplantation in patients with juvenile myelomonocytic leukemia: Report of two cases

Pediatric Transplantation
Koshi AkahaneTakeshi Inukai

Abstract

JMML is an aggressive hematopoietic malignancy of early childhood, and allogeneic HSCT is the only curative treatment for this disease. Umbilical cord blood is one of donor sources for HSCT in JMML patients who do not have an HLA-compatible relative, but engraftment failure remains a major problem. Here, we report two cases of JMML who were successfully rescued by HSCT from an HLA-mismatched parent after development of primary engraftment failure following unrelated CBT. Both patients had severe splenomegaly and underwent unrelated CBT from an HLA-mismatched donor. Immediately after diagnosis of engraftment failure, both patients underwent HSCT from their parent. For the second HSCT, we used RIC regimens consisting of FLU, CY, and a low dose of rabbit ATG with or without TBI and additionally administered ETP considering their persistent severe splenomegaly. Both patients achieved engraftment without severe treatment-related adverse effects. After engraftment of second HSCT, their splenomegaly was rapidly regressed, and both patients showed no sign of relapse for over 4 years. These observations demonstrate that HSCT from an HLA-mismatched parent could be a feasible salvage treatment for primary engraftment failure in JMML patie...Continue Reading

References

Feb 19, 2002·British Journal of Haematology·Franklin O SmithUNKNOWN National Marrow Donor Program
Oct 29, 2008·Leukemia Research·Rebecca J ChanMignon L Loh
Dec 17, 2014·International Journal of Hematology·Miharu YabeUNKNOWN Japanese Pediatric Myelodysplastic Syndrome Study Group
Jun 21, 2016·Pediatrics International : Official Journal of the Japan Pediatric Society·Kazuo SakashitaKenichi Koike

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