title: Third party cord blood transplant boosts autologous hematopoiesis in a case of persistent bone marrow aplasia after double transplant failure for B-thalassemia major.
abstract: A 9-year-old female received an allogeneic stem cell transplant (SCT) from an ABO-incompatible HLA-matched sibling for β-thalassemia major, without achieving a complete donor chimerism. Subsequently, the patient received five donor lymphocyte infusions, without increasing donor chimerism, and autologous SCT. Due to the persistent bone marrow aplasia, the patient received a second allogeneic SCT from the same donor without obtaining any engrafment. After the double transplant failure, we performed an unrelated transplant from a full-matched umbilical cord blood (UCBT) without administering any neither conditioning regimen nor GVHD prophylaxis. Forty days after UCBT, trilinear engraftment was documented. Surprisingly, the hematopoietic reconstitution was related to the re-expansion of the autologous (beta-thalassemic) hematopoietic stem cell, as documented by chimerism studies. At present, 30 months after UCBT, there is stable hematopoietic autologous reconstitution. This is the first description of the restoration of autologous hematopoiesis obtained with UCBT in a thalassemia-major patient after a double transplant failure.
authors.affiliation: Hematology and Hematopoietic Stem Cell Transplant Centre, AORMN Marche Nord Hospital, Pesaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Visani
authors.forename: Paola
authors.initials: P
authors.lastname: Picardi
authors.forename: Barbara
authors.initials: B
authors.lastname: Guiducci
authors.forename: Federica
authors.initials: F
authors.lastname: Loscocco
authors.forename: Claudio
authors.initials: C
authors.lastname: Giardini
authors.forename: Moira
authors.initials: M
authors.lastname: Lucesole
authors.forename: Sara
authors.initials: S
authors.lastname: Barulli
authors.forename: Teresa
authors.initials: T
authors.lastname: Ricciardi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Isidori