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Graft rejection and hyperacute graft‐versus‐host disease in stem cell transplantation from non‐inherited maternal antigen complementary HLA‐mismatched siblings
Author(s) -
Okumura Hirokazu,
Yamaguchi Masaki,
Kotani Takeharu,
Sugimori Naomi,
Sugimori Chiharu,
Ozaki Jun,
Kondo Yukio,
Yamazaki Hirohito,
Chuhjo Tatsuya,
Takami Akiyoshi,
Ueda Mikio,
Ohtake Shigeki,
Nakao Shinji
Publication year - 2007
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2006.00797.x
Subject(s) - microchimerism , medicine , transplantation , immunology , human leukocyte antigen , fludarabine , immunosuppression , stem cell , hematopoietic stem cell transplantation , aplastic anemia , graft versus host disease , antigen , pregnancy , bone marrow , chemotherapy , cyclophosphamide , biology , fetus , genetics
Human leukocyte antigen (HLA)‐mismatched stem cell transplantation from non‐inherited maternal antigen (NIMA)‐complementary donors is known to produce stable engraftment without inducing severe graft‐versus‐host disease (GVHD). We treated two patients with acute myeloid leukemia (AML) and one patient with severe aplastic anemia (SAA) with HLA‐mismatched stem cell transplantation (SCT) from NIMA‐complementary donors (NIMA‐mismatched SCT). The presence of donor and recipient‐derived blood cells in the peripheral blood of recipient (donor microchimerism) and donor was documented respectively by amplifying NIMA‐derived DNA in two of the three patients. Graft rejection occurred in the SAA patient who was conditioned with a fludarabine‐based regimen. Grade III and grade IV acute GVHD developed in patients with AML on day 8 and day 11 respectively, and became a direct cause of death in one patient. The findings suggest that intensive conditioning and immunosuppression after stem cell transplantation are needed in NIMA‐mismatched SCT even if donor and recipient microchimerisms is detectable in the donor and recipient before SCT.