title: Chimerism and T-cell receptor repertoire analysis after unrelated cord blood transplantation with a reduced-intensity conditioning regimen following autologous stem cell transplantation for multiple myeloma.
abstract: A 65-year-old Japanese male was diagnosed as multiple myeloma with Bence Jones kappa type, clinical stage IIIA. His disease status reached partial remission after chemotherapy. Thereafter, he received tandem transplantation, consisting of high-dose chemotherapy with autologous stem cell transplantation (ASCT), followed by unrelated cord blood transplantation (U-CBT). U-CBT with a reduced-intensity conditioning regimen (RI-CBT) was performed in August 2003. HLA mismatch between the patient and the CBT donor was present at two serological loci (B and DR). A total nucleated CBT cell dose of 2.45 x 10(7)/kg body weight was infused on day 0. Graft-vs.-host disease (GVHD) prophylaxis consisted of cyclosporine A and short-term methotrexate. Neutrophil engraftment (>0.5 x 10(9)/l) was obtained on day 46. He developed positive cytomegalovirus antigenemia, grade II acute GVHD involving skin and liver, varicella-zoster virus infection, septic shock, hemorrhagic cystitis caused by adenovirus and acute hepatitis B virus infection after U-CBT. We retrospectively analyzed T-cell receptor (TCR) repertoire diversity and found that TCR repertoire diversity decreased continuously after U-CBT. Therefore, low-TCR repertoire diversity in this patient appears to be associated with various infections caused by immunodeficiency.
authors.affiliation: Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. toubai@hkg.odn.ne.jp
authors.forename: T
authors.initials: T
authors.lastname: Toubai
authors.forename: D
authors.initials: D
authors.lastname: Hirate
authors.forename: Y
authors.initials: Y
authors.lastname: Shono
authors.forename: S
authors.initials: S
authors.lastname: Ota
authors.forename: M
authors.initials: M
authors.lastname: Ibata
authors.forename: S
authors.initials: S
authors.lastname: Mashiko
authors.forename: J
authors.initials: J
authors.lastname: Sugita
authors.forename: A
authors.initials: A
authors.lastname: Shigematsu
authors.forename: Y
authors.initials: Y
authors.lastname: Miura
authors.forename: N
authors.initials: N
authors.lastname: Kato
authors.forename: S
authors.initials: S
authors.lastname: Umehara
authors.forename: K
authors.initials: K
authors.lastname: Kahata
authors.forename: Y
authors.initials: Y
authors.lastname: Tsutsumi
authors.forename: N
authors.initials: N
authors.lastname: Iwao
authors.forename: N
authors.initials: N
authors.lastname: Toyoshima
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.forename: M
authors.initials: M
authors.lastname: Asaka
authors.forename: M
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009101:Multiple Myeloma / Q000628:therapy*; D037182:T-Cell Antigen Receptor Specificity / Q000276:immunology*; D013601:T-Lymphocytes / Q000528:radiation effects; D018183:Transplantation Chimera; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014777:Virus Diseases / Q000150:complications / Q000276:immunology*