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Successful engraftment after cord blood transplantation from an HLA‐homozygous donor (homo‐to‐hetero cord blood transplantation) in a primary myelofibrosis patient with broad HLA antibodies
Author(s) -
Iemura Tomoki,
Itoh Mitsuru,
Mano Chihiro,
Oba Akifumi,
Kawabata Norihiro,
Horisawa Yoshihito,
Matsui Masashi,
Miyahara Yasuko,
Kanda Junya
Publication year - 2018
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.14885
Subject(s) - medicine , cord blood , immunology , human leukocyte antigen , tacrolimus , transplantation , rituximab , graft versus host disease , myelofibrosis , antibody , antigen , bone marrow
BACKGROUND Donor‐specific human leukocyte antigen (HLA) antibodies are a significant risk factor for graft failure in cord blood transplantation (CBT). Although there are several treatments to decrease HLA antibodies, such as platelet transfusion, plasma exchange, rituximab, and bortezomib, their effectiveness has not been established. STUDY DESIGN AND METHODS We herein report the case of a primary myelofibrosis (PMF) patient with broad HLA antibodies who underwent CBT from an HLA‐homozygous donor in which the alleles were matched only in the host‐versus‐graft direction (homo‐to‐hetero CBT). RESULTS The cord blood was killer cell immunoglobulin‐like receptor (KIR) ligand matched. She received a reduced‐intensity conditioning regimen. We used tacrolimus and mycophenolate mofetil as prophylaxis against graft‐versus‐host disease (GVHD). The neutrophils engrafted on Day 31. A chimerism analysis with fluorescence in situ hybridization of peripheral blood cells showed 99.9% donor type on Day 33. She developed only mild acute skin GVHD and chronic skin GVHD. CONCLUSION This case indicates the usefulness of homo‐to‐hetero CBT in a patient with broad HLA antibodies with a strong mean fluorescence intensity, which is a significant risk factor for graft failure. Further studies are necessary to determine the risk of GVHD and to elucidate the association between KIR ligand incompatibility and graft failure in homo‐to‐hetero CBT.