Abstract
Transplantation using umbilical cord progenitor cells as the source of the stem cells is increasingly recognized as another form of allogeneic transplantation with curative intent. However, the different patterns of hematopoietic and immunological reconstruction have been described in very few patients. A 20-month-old boy presented with acute leukemia. He received standard AML induction and consolidation therapy, after which he underwent allogeneic transplantation using HLA-matched sibling stem cells obtained from the umbilical cord. The preparative regimen consisted of busulfan and cyclophosphamide. White cell recovery, despite concomitant use of G-CSF, was slow, reminiscent of the engraftment pattern without the use of growth factor. Erythroid recovery was best recorded using fetal cell HbF level. Platelet transfusion independence occurred on day +31. Immunologic reconstitution revealed an early NK cell recovery by 6 weeks and progressive T cell recovery until 3 months, with continued increase in counts thereafter. However, the CD4/CD8 ratio remained low even at 14 months post-transplantation. Recovery of B cells was slower until day +120. Proliferative response was within normal range on day +120. This report describes the unique engraftment pattern following umbilical cord blood transplant and emphasizes the pattern of immunological and hematological reconstitution.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Armitage JO . Bone marrow transplantation New Engl J Med 1994 330: 827–838
Broxmeyer HE, Gluckman E, Auerbach AD, Douglas GW, Friedman H, Cooper S, Hangoc G, Kurtzberg J, Bard J, Boyse EA . Human umbilical cord blood: a clinically useful source of transplantable hematopoietic stem/progenitor cells Int J Cell Clon 1990 8: (Suppl. 1) 76–91
Gluckman E, Broxmeyer HE, Auerbach AD, Friedman HS, Douglas GW, Devergie A, Esperou H, Thierry D, Socie G, Lehn P . Hematopoietic reconstitution in a patient with Fanconi's anemia by means of umbilical-cord blood from an HLA-identical sibling New Engl J Med 1989 321: 1174–1178
Cairo MS, Wagner JE . Placental and/or umbilical cord blood: an alternative source of hematopoietic stem cells for transplantation Blood 1997 90: 4665–4678
Gluckman E, Rocha V, Boyer-Chammard A, Locatelli F, Arcese W, Pasquini R, Ortega J, Siyillet G, Ferreira E, Laporte JP, Fernandez M, Chastang C . Outcome of cord-blood transplantation from related and unrelated donors New Engl J Med 1997 337: 373–381
Rubinstein P, Carrier C, Scaradavou A, Kurtzberg J, Adamson J, Migliaccio AR, Berkowitz RL, Cabbad M, Dobrila NL, Taylor PE, Rosenfield RE, Stevens CE . Outcomes among 562 recipients of placental-blood transplants from unrelated donors New Engl J Med 1998 339: 1565–1577
Locatelli F, Maccario R, Comoli P, Bertolini F, Giorgiani G, Montagna D, Bonetti F, De Stefano P, Rondini G, Sirchia G, Severi F . Hematopoietic and immune recovery after transplantation of cord blood progenitor cells in children Bone Marrow Transplant 1996 18: 1095–1101
Creutzig U, Harbott J, Sperling C, Ritter J, Zimmermann M, Loffler H, Riehm H, Schellong G, Ludwig WD . Clinical significance of surface antigen expression in children with acute myeloid leukemia: results of study AML-BFM-87 Blood 1995 86: 3097–3108
Dacie JV, Lewis SM . Blood cell cytochemistry and supplementary techniques. In: Catovsky D (ed) Practical Haematology 5th edn: Churchill Livingstone: Edinburgh 1975 pp 143–177
Galanello R, Melis MA, Ruggeri R, Cao A . Prospective study of red blood cell indices, hemoglobin A2 and hemoglobin F in infants heterozygous for beta-thalassemia J Pediatr 1981 99: 105–108
Wagner JE, Broxmeyer HE, Byrd RL, Zehnbauer B, Schmeckpeper B, Shah N, Griffin C, Emanuel PD, Zuckerman KS, Cooper S . Transplantation of umbilical cord blood after myeloablative therapy: analysis of engraftment Blood 1992 79: 1874–1881
Buzby JS, Lee SM, Van Winkle P, DeMaria CT, Brewer G, Cairo MS . Increased granulocyte–macrophage colony-stimulating factor mRNA instability in cord versus adult mononuclear cells is translation-dependent and associated with increased levels of A + U-rich element binding factor Blood 1996 88: 2889–2897
Winkler KJ, Rea CD, Rahbar S, Hill LR, Blume KG . Heterogeneous ontogeny of erythropoiesis after bone marrow ablation and allogeneic bone marrow grafting Blood 1983 61: 167–170
Ault KE, Antin JH, Ginsburg D, Orkin SH, Rappeport JM, Keohan ML, Martin P, Smith BR . Phenotype of recovering lymphoid cell populations after marrow transplantation J Exp Med 1985 161: 1483–1502
Atkinson K . Reconstruction of the haemopoietic and immune systems after marrow transplantation Bone Marrow Transplant 1990 5: 209–226
Keever CA, Small TN, Flomenberg N, Heller G, Pekle K, Black P, Pecora A, Gillio A, Kernan NA, O'Reilly RJ . Immune reconstitution following bone marrow transplantation: comparison of recipients of T cell-depleted marrow with recipients of conventional marrow grafts Blood 1989 73: 1340–1350
Risdon G, Gaddy J, Stehman FB, Broxmeyer HE . Proliferative and cytotoxic responses of human cord blood T lymphocytes following allogeneic stimulation Cell Immunol 1994 154: 14–24
Andersson U, Bird AG, Britton S, Palacios R . Humoral and cellular immunity in humans studied at the cell level from birth to two years of age Immunol Rev 1981 57: 5–12
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Elhasid, R., Ben Arush, M., Pollack, S. et al. Immune and hematopoietic reconstitution after transplantation of cord blood progenitor cells: case report and review of the literature. Leukemia 14, 931–934 (2000). https://doi.org/10.1038/sj.leu.2401738
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.leu.2401738