Switching of donor cells after urgent second cord blood transplantation for suspected graft failure.
Cord blood transplantation (CBT) is being increasingly performed in adults and is now becoming a standard therapeutic alternative to bone marrow transplantation; however, graft failure is one of the associated problems of CBT in adults. A 44-year-old woman with acute myelogenous leukemia in partial remission received an unrelated CBT. Suspected veno-occlusive disease developed, however, and hemopoietic recovery was delayed. A bone marrow examination on the 27th day revealed empty marrow with a relative increase in macrophages, and the serum ferritin concentration was extremely high. Impending failure of the graft due to a hemophagocytic syndrome-like condition was strongly suspected, although donor cells were dominant according to a fluorescence in situ hybridization analysis. A second CBT was performed on the 30th day after a preparatory regimen of methylprednisolone and low-dose fludarabine (total dose, 90 mg/m2). Unexpectedly, the the first donor's cells recovered on the fourth day after the second CBT; however, the cells to finally engraft were those of the second donor. This case is informative as an example of rescue management for suspected graft failure.
Satoh
Naoko
N
Hematology, Nagaoka Red Cross Hospital, 297-1 Terashima-cho, Nagaoka, Niigata, Japan. naokos@nagaoka.jrc.or.jp
Takenouchi
Shoko
S
Hashimoto
Shigeo
S
Fujiwara
Masahiro
M
Koike
Tadashi
T
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001853:Bone Marrow / Q000378:metabolism / Q000473:pathology; D036101:Cord Blood Stem Cell Transplantation; D051799:Delayed Graft Function / Q000097:blood / Q000473:pathology / Q000628:therapy*; D046148:Donor Selection; D005260:Female; D005293:Ferritins / Q000097:blood; D006085:Graft Survival; D006410:Hematopoiesis; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008264:Macrophages / Q000378:metabolism / Q000473:pathology; D008775:Methylprednisolone / Q000008:administration & dosage; D019653:Myeloablative Agonists / Q000008:administration & dosage; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014652:Vascular Diseases / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000628:therapy; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
D000893:Anti-Inflammatory Agents; D019653:Myeloablative Agonists; D005293:Ferritins; D014740:Vidarabine; C024352:fludarabine; D008775:Methylprednisolone