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Successful second cord blood transplantation using fludarabine and cyclophosphamide as a preparative regimen for graft rejection following reduced-intensity cord blood transplantation

Bone Marrow Transplantation volume 40, pages 85–87 (2007)Cite this article

Reduced-intensity cord blood transplantation (RI-CBT) is an attractive alternative for elderly patients and patients with organ impairment who do not have appropriate human leukocyte antigen (HLA)-identical bone marrow or peripheral blood stem cell donors. However, graft rejection may occur after RI-CBT and cause serious difficulties for these patients who require urgent administration of immunosuppressive drugs followed by infusion of another unit of cord blood. We and the other group previously reported the outcome of patients who had received a second CBT for graft rejection using a preparative regimen consisting of fludarabine and melphalan with or without total body irradiation.1, 2 Of the five patients, four achieved primary engraftment. However, three of these patients ultimately died of transplant-related mortality. All five patients developed grades 3–5 regimen-related toxicities (RRTs). These data suggest that RRTs are a major obstacle for successful second CBT after an initial graft rejection and that an optimal RI preparative regimen should be developed. In this paper, we describe successful second RI-CBT using fludarabine and cyclophosphamide without total body irradiation in a patient with initial graft rejection.

A 59-year-old woman received RI-CBT owing to chemorefractory de novo acute myelomonocytic leukemia. She had no available HLA-identical family donors and, owing to disease progression, could not wait for a match from the Japan Marrow Donor Program. The transplant procedures used in this patient are shown in Table 1. The RRTs were evaluated using the Common Terminology Criteria for Adverse Events, version 3.0.3 Chimerism was assessed using polymerase chain reaction as described previously.4 Peripheral cytopenia persisted after RI-CBT. The bone marrow examination on day 20 revealed a few hematopoietic cells and 65% donor chimerism. On day 28, graft rejection was diagnosed based on severe marrow hypoplasia and complete host chimerism of bone marrow cells.

Table 1 Characteristics of the first and second RI-CBTs
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Authors and Affiliations

  1. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    E Mizutani, H Narimatsu, M Murata, A Tomita & T Naoe

  2. Department of Infectious Diseases, Nagoya University School of Medicine, Nagoya, Japan

    H Kiyoi

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  1. E Mizutani
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Correspondence to H Narimatsu.

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Mizutani, E., Narimatsu, H., Murata, M. et al. Successful second cord blood transplantation using fludarabine and cyclophosphamide as a preparative regimen for graft rejection following reduced-intensity cord blood transplantation. Bone Marrow Transplant 40, 85–87 (2007). https://doi.org/10.1038/sj.bmt.1705684

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