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Successful hematopoietic stem cell transplantation from an HLA‐mismatched parent for engraftment failure after unrelated cord blood transplantation in patients with juvenile myelomonocytic leukemia: Report of two cases
Author(s) -
Akahane Koshi,
Watanabe Atsushi,
Furuichi Yoshiyuki,
Somazu Shinpei,
Oshiro Hiroko,
Goi Kumiko,
Sakashita Kazuo,
Muramatsu Hideki,
Hama Asahito,
Takahashi Yoshiyuki,
Koike Kenichi,
Kojima Seiji,
Sugita Kanji,
Inukai Takeshi
Publication year - 2019
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.13378
Subject(s) - juvenile myelomonocytic leukemia , medicine , transplantation , hematopoietic stem cell transplantation , cord blood , human leukocyte antigen , stem cell , transplantation chimera , leukemia , haematopoiesis , umbilical cord , immunology , hematopoietic cell , surgery , antigen , biology , genetics
JMML is an aggressive hematopoietic malignancy of early childhood, and allogeneic HSCT is the only curative treatment for this disease. Umbilical cord blood is one of donor sources for HSCT in JMML patients who do not have an HLA‐compatible relative, but engraftment failure remains a major problem. Here, we report two cases of JMML who were successfully rescued by HSCT from an HLA‐mismatched parent after development of primary engraftment failure following unrelated CBT. Both patients had severe splenomegaly and underwent unrelated CBT from an HLA‐mismatched donor. Immediately after diagnosis of engraftment failure, both patients underwent HSCT from their parent. For the second HSCT, we used RIC regimens consisting of FLU, CY, and a low dose of rabbit ATG with or without TBI and additionally administered ETP considering their persistent severe splenomegaly. Both patients achieved engraftment without severe treatment‐related adverse effects. After engraftment of second HSCT, their splenomegaly was rapidly regressed, and both patients showed no sign of relapse for over 4 years. These observations demonstrate that HSCT from an HLA‐mismatched parent could be a feasible salvage treatment for primary engraftment failure in JMML patients.