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Haploidentical peripheral blood stem cell transplantation without irradiation or busulfan after reduced‐intensity conditioning for KMT 2A( MLL ) ‐rearranged infant B‐cell precursor acute lymphoblastic leukemia: Report of two cases
Author(s) -
Yoshimi Ai,
Kato Keisuke,
Hosaka Sho,
Suzuki Ryoko,
Fukushima Hiroko,
Nakao Tomohei,
Kobayashi Chie,
Fukushima Takashi,
Koike Kazutoshi,
Sumazaki Ryo,
Tsuchida Masahiro
Publication year - 2017
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12918
Subject(s) - medicine , busulfan , sepsis , peripheral blood mononuclear cell , methotrexate , tacrolimus , adverse effect , stem cell , transplantation , gastroenterology , hematopoietic stem cell transplantation , immunology , biochemistry , chemistry , biology , in vitro , genetics
We present two infants with KMT 2A( MLL ) ‐gene‐R‐associated BCP ‐ ALL , who received HLA haploidentical PBSCT after RIC. The patients developed ALL at age 6 months and 3 months, respectively. Case 1 underwent PBSCT at the second CR with detectable KMT 2A‐ AFF 1( MLL ‐ AF 4) fusion gene transcript at 11 months of age, and Case 2 at the first CR without KMT 2A‐ MLLT 1( MLL ‐ ENL ) fusion gene transcript at 8 months of age. Both patients received G‐ CSF ‐mobilized unmanipulated peripheral blood mononuclear cells from their HLA haploidentical mothers after administration of FLU, MEL, and ATG. Tacrolimus, methotrexate, and mPSL were administered as prophylaxis against GVHD . Engraftment was rapidly obtained with complete chimerism in both patients. Acute adverse events included acute GVHD in Case 1 and bacterial sepsis in Case 2. At last clinical check at age 5 years and 4 years, respectively, both patients were recurrence‐free and attained normal growth and development. We conclude that PBSCT from an HLA haploidentical mother with non‐TBI and non‐BU regimen seems feasible and efficacious, offering favorable life quality for infants.