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Engraftment of umbilical cord blood with glucose 6-phosphate dehydrogenase deficiency after double-unit unrelated cord blood transplantation

Bone Marrow Transplantation volume 44, pages 57–58 (2009)Cite this article

The success of unrelated donor (URD) umbilical cord blood transplantation (UCBT) expands the potential pool of URD for hematopoietic SCT (HSCT). UCBT requires less stringent HLA matching than do other forms of HSCT, which does not apparently increase the frequency of graft failure or GVHD. Engraftment is related to total cell count per unit body weight. For adult recipients, double-unit UCB transplantation may be required for long-term engraftment.1 Despite the infusion of two units of UCB, one unit finally engrafts.2

A 47-year-old man with AML in second CR underwent a URD double-unit UBCT, with standard BU and CY as conditioning, and MTX and CYA as GVHD prophylaxis. Infection prophylaxis included ganciclovir, caspofungin, pentamidine, and lamivudine and isoniazid for chronic hepatitis B virus infection and past tuberculosis, respectively. He engrafted hematologically on day 25 with grade III acute GVHD of the skin and liver, associated with hemorrhagic cystitis. These complications were controlled with corticosteroids and mycophenolate mofetil. Serial peripheral blood DNA chimerism was monitored by semiquantitative PCR for polymorphic microsatellite loci as reported earlier.3 The results showed engraftment initially of both UCB units, but ultimately of one unit only (Table 1). As one UCB unit came from a known glucose-6-phosphate dehydrogenase (G6PD)-deficient donor, serial assays of G6PD were performed. The results showed a gradual decrease of G6PD to the deficiency level, consistent with the results of DNA chimerism.3 Therefore, the G6PD-deficient UCB had engrafted successfully, as shown both by DNA chimerism and the surrogate marker G6PD level.

Table 1 Serial monitoring results after unrelated cord blood transplantation (UCBT)
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  1. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China. E-mail: auwing@hotmail.com,

    W Y Au, A K W Lie, K Y Lam & Y L Kwong

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  1. W Y Au
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  2. A K W Lie
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  3. K Y Lam
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  4. Y L Kwong
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Au, W., Lie, A., Lam, K. et al. Engraftment of umbilical cord blood with glucose 6-phosphate dehydrogenase deficiency after double-unit unrelated cord blood transplantation. Bone Marrow Transplant 44, 57–58 (2009). https://doi.org/10.1038/bmt.2008.422

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