Successful treatment of secondary graft failure in a mixed-phenotype acute leukemia patient with haploidentical hematopoietic stem cell transplantation and post-transplant cyclophosphamide administration

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  • KATAYAMA Oju
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • HONDA Shuhei
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • YOSHIDA Natsumi
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • NAGAMATSU Kentaro
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • TAKANO Kuniko
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • KAWANO Rie
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • OGATA Masao
    Department of Hematology, Oita University Hospital
  • SHIRAO Kuniaki
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine

Bibliographic Information

Other Title
  • 二次生着不全に対して移植後シクロフォスファミドを用いたHLA半合致移植が有効であった急性混合性白血病
  • 症例報告 二次生着不全に対して移植後シクロフォスファミドを用いたHLA半合致移植が有効であった急性混合性白血病
  • ショウレイ ホウコク ニジセイチャク フゼン ニ タイシテ イショク ゴ シクロフォスファミド オ モチイタ HLA ハンガッチ イショク ガ ユウコウ デ アッタ キュウセイ コンゴウセイ ハッケツビョウ

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Abstract

<p>A 38-year-old woman in the first remission of mixed-phenotype acute leukemia underwent unrelated bone marrow transplantation from an HLA-DR-mismatched donor in the host-versus-graft (HVG) direction with myeloablative conditioning. Neutrophil engraftment was achieved and complete donor chimera was obtained on days 21 and 29 after transplantation, respectively. Subsequently, with delayed blood cell recovery, continuous transfusion was needed to replace platelets. In the CD3 peripheral blood chimerism test, the percentage of recipient cells on days 50, 63, and 80 was 27.3%, 90%, and 95% or higher, respectively. With no relapse of leukemia observed on bone marrow examination, secondary graft failure associated with autologous hematopoietic recovery was diagnosed. Bone marrow transplantation from the patient’s HLA-haploidentical sister was performed because of graft failure on day 111 after the initial transplant using post-transplant cyclophosphamide (PTCy). Neutrophil engraftment was achieved and complete donor chimera was obtained on days 14 and 21 after the second transplantation, respectively. With no serious complications or acute graft versus host disease, the patient was discharged with symptomatic improvement. According to our results, retransplant using PTCy obtained from an HLA-haploidentical sibling donor is a potential treatment for graft failure.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 59 (5), 485-488, 2018

    The Japanese Society of Hematology

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