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Successful unrelated donor cord blood transplantation for adult sickle cell disease and Hodgkin lymphoma

Bone Marrow Transplantation volume 45, page 1252 (2010)Cite this article

Unrelated donor cord blood (CB) offers an alternative hematopoietic stem cell (HSC) source for racial and ethnic minorities who lack suitable sibling donors and are under-represented in unrelated volunteer donor registries. We report the case of a 22-year-old African-American woman with a history of sickle cell disease (SCD) complicated by pain crises, cerebrovascular disease, nephropathy, chronic leg ulcers and cholelithiasis. She was also diagnosed with stage IA nodular sclerosis Hodgkin lymphoma (HL) in 1999, and was placed in CR with four cycles of combination chemotherapy (COPP/ABV). However, in 2007 she relapsed with bulky stage IVB disease. She achieved a second CR after COPP/ABV with high-dose cytarabine and etoposide, which was complicated by pain crises, bacterial sepsis and status epilepticus. The patient did not have any HLA-matched siblings or unrelated volunteer donors, the latter influenced by her African ancestry. Therefore, she was transplanted with 5/6 HLA-A,-B antigen and -DRB1 allele-matched CB using a double-unit graft to augment engraftment (total nucleated cell dose 3.8 × 107/kg and 2.0 × 107/kg)1 after reduced intensity conditioning (RIC). Neutrophil recovery occurred by day +15 post-transplant with complete sustained donor engraftment of only one CB unit.1 Transplant was complicated by cytomegalovirus viremia and shingles, both of which responded promptly to therapy. The patient had no GVHD and immunosuppression was stopped after 6 months. At 18 months post-transplant, the patient remains fully engrafted, has a normal hemoglobin concentration, a sustained CR of HL, and enjoys a normal performance status.

Allogeneic HSC transplantation is an accepted treatment for relapsed or refractory HL2, 3 that offers the potential benefit of a GVL effect.2 Allogeneic transplantation is also an alternative treatment for SCD but is limited by the lack of suitably matched donors and the risk of TRM in patients with advanced end-organ disease. Reports are therefore largely limited to related donor transplants in children.4 Although the use of CB as a HSC source is appealing because of the reduced stringency of the required HLA match, unrelated CB transplantation (CBT) after RIC has been associated with a high risk of rejection.5 Our report shows the feasibility of unrelated donor CBT for the treatment of adult SCD from the standpoint of toxicity. We acknowledge that the patient's prior chemotherapy and its associated immunosuppression likely facilitated prompt donor engraftment. Therefore, CBT using conditioning regimens that ensure sufficient recipient immunosuppression, but avoid the toxicity of high-dose chemoradiation, merits investigation in adults with SCD.

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References

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Authors and Affiliations

  1. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    C Sauter & J N Barker

  2. Department of Pediatrics, New York University Medical Center, New York, NY, USA

    A R Rausen

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  1. C Sauter
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  2. A R Rausen
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  3. J N Barker
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Correspondence to C Sauter.

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Sauter, C., Rausen, A. & Barker, J. Successful unrelated donor cord blood transplantation for adult sickle cell disease and Hodgkin lymphoma. Bone Marrow Transplant 45, 1252 (2010). https://doi.org/10.1038/bmt.2009.317

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