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Unrelated cord blood transplant as salvage following non-engraftment of unrelated marrow transplant?

Bone Marrow Transplantation volume 34, pages 275–276 (2004)Cite this article

Unrelated donor (URD) BMT is being performed more often for children with non-malignant life-threatening disorders. As GVHD is of no possible benefit in this patient group, T-cell depletion (TCD) may be used to minimize the risk of GVHD. Non-engraftment or graft failure is more common among BMT recipients who have received minimal prior chemotherapy, and among patients receiving TCD grafts. A second BMT may be required for such patients who reject their first graft. After rejection of the first BMT, TCD is unlikely to be used for a second procedure, but GVHD is still a concern in this patient population. In this situation, cord blood transplantation (CBT) may be an option, although CBT has itself been associated with an increased risk of graft rejection. We report two children with non-malignant conditions who successfully engrafted following unrelated CBT after failing to engraft following T-depleted unrelated donor BMT.

Patient 1 was an asymptomatic 16-month boy with metachromatic leukodystrophy (MLD). An URD matched at HLA A, B and DRB1, DQB1 with a C mismatch was located. He was conditioned with BUCY and antithymocyte globulin (ATG). The bone marrow was treated by TCD using sheep red blood cell rosetting, and he received a transfusion of 1.5 × 108/kg nucleated cells, 1.1 × 106/kg CD34 cells and 3.0 × 105/kg CD3 cells. Prophylaxis against GVHD consisted of the TCD and CsA. He failed to engraft, received an autologous reinfusion of bone marrow and then recovered his count. An immune-mediated rejection process was suspected clinically and a second donor was also considered unsuitable because they shared the same HLA C antigen with the original donor that was disparate from the patient's HLA C antigen. An unrelated cord mismatched at one HLA A antigen was identified. Subsequently, it was shown that this cord unit was also matched at the HLA C locus.

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Authors and Affiliations

  1. Department of Oncology, BMT Service, The Children's Hospital at Westmead, Westmead, NSW, Australia

    P J Shaw, M Bleakley & L Lau

  2. Discipline of Paediatrics and Child Health, Sydney University, Australia

    P J Shaw

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  1. P J Shaw
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  2. M Bleakley
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  3. L Lau
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Shaw, P., Bleakley, M. & Lau, L. Unrelated cord blood transplant as salvage following non-engraftment of unrelated marrow transplant?. Bone Marrow Transplant 34, 275–276 (2004). https://doi.org/10.1038/sj.bmt.1704557

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