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Haemopoietic stem cell transplantation induces tolerance to donor antigens but not to foreign FVIII peptides
Author(s) -
UPRICHARD J.,
DAZZI F.,
APPERLEY J. F.,
LAFFAN M. A.
Publication year - 2010
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/j.1365-2516.2009.02099.x
Subject(s) - medicine , immunology , transplantation , stem cell , immune system , immune tolerance , conditioning regimen , haematopoiesis , hematopoietic stem cell transplantation , alemtuzumab , biology , genetics
Summary. A 22‐year‐old male with severe haemophilia A and high responding factor VIII (FVIII) inhibitor underwent sibling haematopoietic stem cell transplantation in an attempt to eradicate the inhibitor. A reduced intensity conditioning regimen was followed by bone marrow infusion and continuous FVIII administration during immune reconstitution. Although substantial levels of FVIII:C (>100 IU dL −1 ) were maintained initially, at day +23 inhibitor titres rose, indicating boosting of recipient memory repertoire, despite complete donor chimerism. On day +46, he developed Klebsiella pneumoniae septicaemia and died. This case shows that, despite very successful transplantation tolerance, the procedure failed to control long‐term memory effector immune cells.