Graft rejection and hyperacute graft-versus-host disease in stem cell transplantation from non-inherited maternal-antigen-complementary HLA-mismatched siblings.
Human leukocyte antigen (HLA)-mismatched stem cell transplantation from non-inherited maternal antigen (NIMA)-complementary donors is known to produce stable engraftment without inducing severe graft-versus-host disease (GVHD). We treated two patients with acute myeloid leukemia (AML) and one patient with severe aplastic anemia (SAA) with HLA-mismatched stem cell transplantation (SCT) from NIMA-complementary donors (NIMA-mismatched SCT). The presence of donor and recipient-derived blood cells in the peripheral blood of recipient (donor microchimerism) and donor was documented respectively by amplifying NIMA-derived DNA in two of the three patients. Graft rejection occurred in the SAA patient who was conditioned with a fludarabine-based regimen. Grade III and grade IV acute GVHD developed in patients with AML on day 8 and day 11 respectively, and became a direct cause of death in one patient. The findings suggest that intensive conditioning and immunosuppression after stem cell transplantation are needed in NIMA-mismatched SCT even if donor and recipient microchimerisms is detectable in the donor and recipient before SCT.
Okumura
Hirokazu
H
Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. hokumura@med3.m.kanazawa-u.ac.jp
Yamaguchi
Masaki
M
Kotani
Takeharu
T
Sugimori
Naomi
N
Sugimori
Chiharu
C
Ozaki
Jun
J
Kondo
Yukio
Y
Yamazaki
Hirohito
H
Chuhjo
Tatsuya
T
Takami
Akiyoshi
A
Ueda
Mikio
M
Ohtake
Shigeki
S
Nakao
Shinji
S
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D001752:Blast Crisis / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D002678:Chimera / Q000235:genetics / Q000276:immunology*; D036101:Cord Blood Stem Cell Transplantation; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000235:genetics / Q000276:immunology*; D006086:Graft vs Host Disease / Q000235:genetics / Q000276:immunology* / Q000517:prevention & control; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D007112:Immunity, Maternally-Acquired; D007519:Isoantigens / Q000276:immunology; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000473:pathology; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D012074:Remission Induction; D035781:Siblings; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
D006680:HLA Antigens; D007519:Isoantigens; D014740:Vidarabine; C024352:fludarabine