Purified CD34-Positive Peripheral Blood Stem Cell Transplantation from a HLA-Haploidentical Mother to an Infant with Relapsed Acute Lymphoblastic Leukemia.

概要

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An 8-month-old girl with refractory acute lymphoblastic leukemia with del (11q23) underwent a purified CD34+ peripheral blood stem cell (PBSC) transplantation from her HLA-haploidentical mother. PBSC were mobilized with G-CSF (10 μg/kg/day for 5 days) and collected at day 5 of G-CSF treatment. The CD34+ cells were separated by using an immunomagnetic cell-separation system (Isolex 300®). The conditioning regimen consisted of busulfan (600 mg/m2), etoposide (60 mg/kg), melphalan (195 mg/m2), and total lymphoid irradiation (7.5 Gy/6 fractions). The number of infused CD34+ cells, colony forming unit-granulocyte/macro-phage (CFU-GM), and CD3+ cells were 3.4 × 106/kg, 2.6 × 106/kg, and 2.8 × 104/kg, respectively. Neutrophil counts increased above 500/μl by day 18. No serious acute GVHD was seen without graft versus host disease (GVHD) prophylaxis. However, the patient died of respiratory failure on day 22. Autopsy findings revealed disseminated aspergillosis, but no evidence of leukemia or GVHD. Purified CD34+ PBSC transplantation from HLA-haploidentical related donors should be considered for patients with refractory leukemia without an appropriate donor. Overcoming lethal infectious complications is crucial to the establishment of this method.
特定非営利活動法人　日本小児血液・がん学会の論文