HLA Haplotype Identical Cord Blood Stem Cell Transplantation from Sibling as a Second Graft for Infantile Leukemia.

概要

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We performed HLA one haploidentical cord blood stem cell transplantation (CBSCT) from a sex-mismatched sibling for a case of infantile ALL. This case developed hematological and meningeal relapse after receiving an autologous bone marrow transplantation and could not find an HLA-matched donor. The CBSCT was done on 16 February 1996. He received 2.5 × 107 mononuclear cells/kg (5 × 104 CD34-positive cells/kg) after conditioning with craniospinal irradiation (6 Gy), TBI (12 Gy), thio-TEPA (600 mg/m2) and cyclophosphamide (120 mg/kg). Cyclosporine was used for GVHD prophylaxis. Ganciclovir (GCV) was administered from day -9 to day -2 because the patient was CMV-seropositive. G-CSF was given from day 3. Neutrophil counts rose to 0.5 × 109/l on day 17. Complete chimerism was confirmed by the detection of XX chromosome in peripheral blood nuclear cells by FISH on day 28. He developed grade III acute GVHD with resolution by repeated pulse therapy (high-dose methylprednisolone) and tacrolimus. Chronic GVHD (skin and gut) subsequently developed and was controlled well with prednisolone alone. He suffered from CMV enteritis on day 152, which was successfully treated by GCV. This case is doing well two years after CBSCT. It is suggestive that haploidentical CBSCT from a sibling is feasible under the sufficient GVHD prophylaxis and proper supportive therapy.
特定非営利活動法人　日本小児血液・がん学会の論文