TREATMENT OF A CHILD SUFFERING FROM
HIGH-RISK ACUTE LYMPHOBLASTIC LEUKAEMIA WITH T-CELL-DEPLETED STEM CELLS
FROM HIS MOTHER WITH ONE FULLY MISMATCHED HLA HAPLOTYPE
Wu Xuedong, Li CHF,
Zhang YM
Department
of Paediatrics, Nanfang Hospital, Guangzhou, China
Objective: To study the
possibility of Bone Marrow Transplantation (BMT) for high-risk acute lymphoblastic
leukemia using HLA (human leukocyte antigen) mismatched mother donor.
Methods: The patient
is a boy, eight months old. When he was six months old, he was diagnosed as
acute lymphoblastic leukemia. The white blood cell was 310×109/L.
We gave him induction therapy and consolidation therapy before BMT.As he
had no sibling and no unrelated matched donor, His mother, HLA mismatched
(3/6),was selected as the donor.Conditioning regimen included Fludarabine
200mg/m2, Thiotepa 25mg/kg, TBI (total
body irradiation) 4Gy, VP16 1200mg/m2 and ATG (Antithymocyte globulin) 50mg/d. Prophylaxis of
GVHD (graft versus host disease) include CsA(Cyclopsprin
A) .We used high dose of CD34+ cell about 20×106/kg,
and CD3+ cell 6.5×106/kg with
cliniMACS.
Results: Complete
donor chimerism was detected with FISH (fluorescence in situ hybridization)
on day +26, +60. I degree of a GVHD was seen. Bone marrow examination
showed low nucleated cell proliferation. The white blood cells usually was
under 1×109/L. Unfortunately, the child died of sirious
infection on day +63.
Conclusion: Bone Marrow
Transplantation for high-risk acute lymphoblastic leukemia using three HLA
mismatched mother donor may be possible,but the technology of positive
selection of CD34+ cells is not mature in China.