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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.
- Source :
-
Pediatric transplantation [Pediatr Transplant] 2019 May; Vol. 23 (3), pp. e13378. Date of Electronic Publication: 2019 Feb 20. - Publication Year :
- 2019
-
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 patients.<br /> (© 2019 Wiley Periodicals, Inc.)
- Subjects :
- Child, Preschool
Female
Fetal Blood
Hepatomegaly surgery
Humans
Immunosuppressive Agents therapeutic use
Infant
Male
Mutation
Recurrence
Splenomegaly surgery
Transplantation Conditioning
Treatment Outcome
Cord Blood Stem Cell Transplantation methods
HLA Antigens immunology
Hematopoietic Stem Cell Transplantation methods
Hematopoietic Stem Cells cytology
Leukemia, Myelomonocytic, Juvenile therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1399-3046
- Volume :
- 23
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Pediatric transplantation
- Publication Type :
- Report
- Accession number :
- 30786117
- Full Text :
- https://doi.org/10.1111/petr.13378