Switching of donor cells after urgent second cord blood transplantation for suspected graft failure

International Journal of Hematology
Naoko SatohTadashi Koike

Abstract

Cord blood transplantation (CBT) is being increasingly performed in adults and is now becoming a standard therapeutic alternative to bone marrow transplantation; however, graft failure is one of the associated problems of CBT in adults. A 44-year-old woman with acute myelogenous leukemia in partial remission received an unrelated CBT. Suspected veno-occlusive disease developed, however, and hemopoietic recovery was delayed. A bone marrow examination on the 27th day revealed empty marrow with a relative increase in macrophages, and the serum ferritin concentration was extremely high. Impending failure of the graft due to a hemophagocytic syndrome-like condition was strongly suspected, although donor cells were dominant according to a fluorescence in situ hybridization analysis. A second CBT was performed on the 30th day after a preparatory regimen of methylprednisolone and low-dose fludarabine (total dose, 90 mg/m2). Unexpectedly, the the first donor's cells recovered on the fourth day after the second CBT; however, the cells to finally engraft were those of the second donor. This case is informative as an example of rescue management for suspected graft failure.

References

Apr 1, 1997·International Journal of Hematology·H Tsuda
Aug 13, 2002·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Elizabeth J ShpallIan K McNiece
Dec 24, 2005·British Journal of Haematology·Hiroto NarimatsuShuichi Taniguchi
Jun 6, 2006·Bone Marrow Transplantation·H SchoemansJ Wagner

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Citations

May 27, 2009·Current Opinion in Hematology·Lisa M ArfonsHillard M Lazarus
Apr 27, 2019·Reviews in the Neurosciences·Ahmad MehdipourAbbas Ebrahimi-Kalan

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