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- Publisher Website: 10.1111/petr.13945
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- PMID: 33314508
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Article: Repeated CD45RA-depleted DLI successfully increases donor chimerism in a patient with beta-thalassemia major after haploidentical stem cell transplant
Title | Repeated CD45RA-depleted DLI successfully increases donor chimerism in a patient with beta-thalassemia major after haploidentical stem cell transplant |
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Authors | |
Keywords | beta-thalassemia bone marrow transplantation chimerism hematopoietic stem cell transplantation lymphocyte transfusion |
Issue Date | 2021 |
Publisher | Wiley-Blackwell Publishing, Inc. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1399-3046 |
Citation | Pediatric Transplantation, 2021, v. 25 n. 5, article no. e13945 How to Cite? |
Abstract | Allogeneic hematopoietic stem cell transplantation is curative for transfusion-dependent thalassemia, but mixed chimerism (MC) may herald graft rejection. We report a child who failed bone marrow transplant (BMT) from matched unrelated donor (MUD) successfully salvaged with haploidentical peripheral blood stem cell transplant (PBSCT), but had MC in T-lymphocyte compartment despite near-complete donor chimerism in myeloid compartment. MC was successfully improved by repeated CD45RA-depleted donor lymphocyte infusion (DLI). A 2-year-old Chinese girl with beta-thalassemia major underwent 12/12-MUD BMT with HU/AZA/Cy/Flu/Bu/TT conditioning resulted in graft rejection. As donor refused second donation, rescue haploidentical PBSCT was performed with alemtuzumab/fludarabine/treosulfan conditioning. Harvest product was CD3/CD45RA depleted with extra products cryopreserved. Split cell chimerism performed 1-month after haplo-transplant showed 97% mother, 3% MUD, and 0% host for granulocytes but 38% mother, 62% MUD, and 0% host for CD3 + T cells. In view of low haploidentical donor chimerism in T-lymphocyte compartment, CD45RA-depleted DLI using cryopreserved product was performed on day + 38, after thymoglobulin 3 mg/kg given as T-cell depletion 3 days beforehand. T-cell chimerism improved to 51% mother and 49% MUD post-DLI. Second cryopreserved CD45RA-depleted DLI was given 17 days after the first DLI (day + 55), and 100% full chimerism of mother's T cells was gradually established without significant graft-versus-host disease (GVHD) or viral reactivation. To conclude, split lineage chimerism determination is beneficial to guide management strategy. For MC in T-cell compartment, CD45RA-depleted DLI is a potential alternative to unselected T cells as it carries lower risk of GVHD and infection. |
Persistent Identifier | http://hdl.handle.net/10722/306423 |
ISSN | 2023 Impact Factor: 1.2 2023 SCImago Journal Rankings: 0.494 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Chan, YKW | - |
dc.contributor.author | Kwok, JSY | - |
dc.contributor.author | Chiang, AKS | - |
dc.contributor.author | Chan, GCF | - |
dc.contributor.author | Lee, PPW | - |
dc.contributor.author | Ha, SY | - |
dc.contributor.author | Cheuk, KLD | - |
dc.date.accessioned | 2021-10-22T07:34:24Z | - |
dc.date.available | 2021-10-22T07:34:24Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | Pediatric Transplantation, 2021, v. 25 n. 5, article no. e13945 | - |
dc.identifier.issn | 1397-3142 | - |
dc.identifier.uri | http://hdl.handle.net/10722/306423 | - |
dc.description.abstract | Allogeneic hematopoietic stem cell transplantation is curative for transfusion-dependent thalassemia, but mixed chimerism (MC) may herald graft rejection. We report a child who failed bone marrow transplant (BMT) from matched unrelated donor (MUD) successfully salvaged with haploidentical peripheral blood stem cell transplant (PBSCT), but had MC in T-lymphocyte compartment despite near-complete donor chimerism in myeloid compartment. MC was successfully improved by repeated CD45RA-depleted donor lymphocyte infusion (DLI). A 2-year-old Chinese girl with beta-thalassemia major underwent 12/12-MUD BMT with HU/AZA/Cy/Flu/Bu/TT conditioning resulted in graft rejection. As donor refused second donation, rescue haploidentical PBSCT was performed with alemtuzumab/fludarabine/treosulfan conditioning. Harvest product was CD3/CD45RA depleted with extra products cryopreserved. Split cell chimerism performed 1-month after haplo-transplant showed 97% mother, 3% MUD, and 0% host for granulocytes but 38% mother, 62% MUD, and 0% host for CD3 + T cells. In view of low haploidentical donor chimerism in T-lymphocyte compartment, CD45RA-depleted DLI using cryopreserved product was performed on day + 38, after thymoglobulin 3 mg/kg given as T-cell depletion 3 days beforehand. T-cell chimerism improved to 51% mother and 49% MUD post-DLI. Second cryopreserved CD45RA-depleted DLI was given 17 days after the first DLI (day + 55), and 100% full chimerism of mother's T cells was gradually established without significant graft-versus-host disease (GVHD) or viral reactivation. To conclude, split lineage chimerism determination is beneficial to guide management strategy. For MC in T-cell compartment, CD45RA-depleted DLI is a potential alternative to unselected T cells as it carries lower risk of GVHD and infection. | - |
dc.language | eng | - |
dc.publisher | Wiley-Blackwell Publishing, Inc. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1399-3046 | - |
dc.relation.ispartof | Pediatric Transplantation | - |
dc.rights | This is the peer reviewed version of the following article: Pediatric Transplantation, 2021, v. 25 n. 5, article no. e13945, which has been published in final form at https://doi.org/10.1111/petr.13945. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. | - |
dc.subject | beta-thalassemia | - |
dc.subject | bone marrow transplantation | - |
dc.subject | chimerism | - |
dc.subject | hematopoietic stem cell transplantation | - |
dc.subject | lymphocyte transfusion | - |
dc.title | Repeated CD45RA-depleted DLI successfully increases donor chimerism in a patient with beta-thalassemia major after haploidentical stem cell transplant | - |
dc.type | Article | - |
dc.identifier.email | Chan, YKW: wykchan@hku.hk | - |
dc.identifier.email | Chiang, AKS: chiangak@hku.hk | - |
dc.identifier.email | Chan, GCF: gcfchan@hku.hk | - |
dc.identifier.email | Lee, PPW: ppwlee@hku.hk | - |
dc.identifier.email | Ha, SY: syha@hku.hk | - |
dc.identifier.email | Cheuk, KLD: klcheuk@hkucc.hku.hk | - |
dc.identifier.authority | Chiang, AKS=rp00403 | - |
dc.identifier.authority | Chan, GCF=rp00431 | - |
dc.identifier.authority | Lee, PPW=rp00462 | - |
dc.description.nature | postprint | - |
dc.identifier.doi | 10.1111/petr.13945 | - |
dc.identifier.pmid | 33314508 | - |
dc.identifier.scopus | eid_2-s2.0-85097442240 | - |
dc.identifier.hkuros | 328947 | - |
dc.identifier.volume | 25 | - |
dc.identifier.issue | 5 | - |
dc.identifier.spage | article no. e13945 | - |
dc.identifier.epage | article no. e13945 | - |
dc.identifier.isi | WOS:000597642900001 | - |
dc.publisher.place | United States | - |