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Infusion of autologous peripheral blood stem cells in an unrelated donor who developed severe aplastic anemia following stem cell donation

Bone Marrow Transplantation volume 47, page 869 (2012)Cite this article

We evaluated a 33 year-old gentleman for peripheral blood stem cell donation for an unrelated recipient. Evaluation at that time was significant for obesity. He was not on any medications. His laboratory evaluation revealed normal complete blood count with WBC of 7500/μL, Hb of 16.1 g/dL and platelet count of 352 000/μL. He was cleared to donate and was mobilized with G-CSF with a dose of 10 mcg/kg daily for 5 days. On the fifth day, his WBC was 38 600/μL, platelet count of 368 000/μL, Hb of 15.3 g/dL and absolute CD34+ cell count of 208 cells/μL. A total of 169.72 × 107 CD34+cells were collected and sent to the unrelated recipient. The donor had no unusual events related to the donation and was fully recovered 2 weeks after donation. He was well until 9 months post-donation, when he developed sinusitis that was treated with a short course of oral antibiotics. After 4 weeks, he presented to his local physician with petechiae and his laboratory evaluation revealed a WBC 400/μL, ANC of <200/μL, platelet count of 4000/μL and a Hb of 9 g/dL. BM biopsy revealed markedly hypocellular BM with trilineage hypoplasia with normal male karyotype on cytogenetic analysis. Fluorescence in-situ hybridization for myelodysplastic syndrome-associated abnormalities failed to detect any cytogenetic abnormalities. Flow cytometry did not show evidence of paroxysmal nocturnal hemoglobinuria. As the patient remained transfusion dependent and he did not have any HLA identical siblings, he was started on immune suppression with cyclosporine and antithymocyte globulin as has been previously described.1 He remained transfusion-dependent 8 weeks following the initiation of immune suppression; contact was made with the National Marrow Donor Program (NMDP) to inquire if there were any PBSC left following the transplant of the recipient. The recipient was well engrafted and there were remaining unused CD34+ cells stored at the recipient's transplant center. After consulting with the transplant center physicians and the recipient, 37.5 × 107 cells were transferred back to our center.

After 3 months of the diagnosis of severe aplastic anemia and 1 year post-PBSC donation, the patient received cyclophosphamide 50 mg/kg daily for four doses followed by infusion of his autologous stem cells at a total dose 2.64 × 106/kg CD34+ cells. He did well and has achieved neutrophil engraftment (ANC>500 for 3 days) and platelet engraftment on day +11 and +20, respectively, post-stem cell infusion. With a 4-month follow-up the patient is well engrafted and is transfusion independent.

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References

  1. Frickhofen N, Rosenfeld SJ . Immunosuppressive treatment of aplastic anemia with antithymocyte globulin and cyclosporine. Semin Hematol 2000; 37: 56–68.

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Authors and Affiliations

  1. Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA

    H Frangoul

  2. National Marrow Donor Program, Minneapolis, MN, USA

    W H Navarro & D L Confer

  3. Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    M Jagasia

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  1. H Frangoul
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  2. W H Navarro
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  3. D L Confer
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  4. M Jagasia
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Correspondence to H Frangoul.

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Frangoul, H., Navarro, W., Confer, D. et al. Infusion of autologous peripheral blood stem cells in an unrelated donor who developed severe aplastic anemia following stem cell donation. Bone Marrow Transplant 47, 869 (2012). https://doi.org/10.1038/bmt.2011.174

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