Related Haploidentical Peripheral Blood Stem Cell Transplantation as a Rescue after Double Cord Blood Unit Graft Rejection in an Anti-HLA-Immunized Patient

A reduced intensity conditioned related haploidentical stem cell transplantation was performed as a rescue after an allogeneic unrelated double cord blood units transplantation failure for a secondary myelodysplasia with a large anti-HLA immunization. The conditioning regimen consisted of thiotepa 5 mg/m2 on D 7, fludarabine 40 mg/m2 on D 6 to D 3, IV busilvex 3.2 mg/m2 on D 6 and D 5, thymoglobulin 2.5 mg/kg on D 1. Graft versus host disease prophylaxis started with IV ciclosporin 3 mg/kg and oral mycophenolate mofetyl 1 g twice a day on D + 6 with corticosteroids (1 mg/kg) between D0 and D + 5, IV cyclophosphamide 50 mg/m2 was administered on D + 3 and D + 5 post-transplantation. Engraftment occurred on D + 16 with neutrophil recovery (> 1G/l) and normal marrow activity with no sign of myelodysplasia and 100% donor chimerism on D + 55. However there was any platelet recovery and the patient presented massive BK virus and cyclophosphamide related acute bleed in cystitis with obstructive clots and acute renal failure. Despite treatment based upon intravenous and intravesical cidofovir, the patient died on D + 145 due to severe BK virus and bacterial infection with multiple organ failure.