title: Successful T-cell-replete peripheral blood stem cell transplantation from HLA-haploidentical microchimeric mother to daughter with refractory acute lymphoblastic leukemia using reduced-intensity conditioning.
abstract: A 16-year-old girl with refractory acute lymphoblastic leukemia underwent reduced-intensity hematopoietic stem cell transplantation from her two-locus-mismatched haploidentical mother, who was microchimeric for the patient's hematopoietic cells. The conditioning regimen comprised melphalan, fludarabine, and low-dose total body irradiation. Non-T-cell-depleted peripheral blood stem cells were infused with graft-versus-host disease (GVHD) prophylaxis consisting of tacrolimus, prednisolone, and short-course methotrexate. Complete donor-type engraftment without evidence of residual leukemia was confirmed on day 22. Severe GVHD was not observed despite rapid cessation of immunosuppression. The patient remains well in continuous remission 15 months after transplant. This successful experience suggests that maternal hematopoietic stem cell transplants for children, in the presence of microchimerism, may be associated with hyporesponsiveness to the inherited paternal HLA antigens (IPA); preventing severe GVHD.
authors.affiliation: Department of Pediatrics, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Umeda
authors.forename: S
authors.initials: S
authors.lastname: Adachi
authors.forename: H
authors.initials: H
authors.lastname: Ishihara
authors.forename: Y
authors.initials: Y
authors.lastname: Higashi
authors.forename: M
authors.initials: M
authors.lastname: Shiota
authors.forename: K-I
authors.initials: KI
authors.lastname: Watanabe
authors.forename: M
authors.initials: M
authors.lastname: Hishizawa
authors.forename: T
authors.initials: T
authors.lastname: Ichinohe
authors.forename: T
authors.initials: T
authors.lastname: Kitoh
authors.forename: E
authors.initials: E
authors.lastname: Maruya
authors.forename: H
authors.initials: H
authors.lastname: Saji
authors.forename: T
authors.initials: T
authors.lastname: Uchiyama
authors.forename: T
authors.initials: T
authors.lastname: Nakahata
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D009035:Mothers; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D033581:Stem Cell Transplantation / Q000379:methods*; D013997:Time Factors; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014916:Whole-Body Irradiation