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Successful non-T-cell-depleted HLA-haploidentical 3-loci mismatched bone marrow transplantation.

Yagyu S, Kuroda H, Fujiki A, Tamura S, Iehara T, Morimoto A, Hosoi H, Sugimoto T, Imashuku S

Department of Pediatrics, Kyoto City Hospital, Kyoto, Japan. shigeky@m7.dion.ne.jp

A 17-year-old boy with therapy-related acute myelocytic leukemia (FAB classification-M0) successfully received allogeneic non-T-cell depleted (non-TCD) bone marrow transplantation (BMT) from his 3-loci HLA-mismatch mother, although pre-BMT detection of feto-maternal microchimerism was negative. The BMT was performed with reduced intensity conditioning (total body irradiation; 4 Gy, fludarabine; 20 mg/m(2) x 6, and melphalan; 70 mg/m(2) x 2) and short-course methotrexate and tacrolimus for GVHD prophylaxis. Complete donor chimera was obtained on day 19, associated with Grade 3 acute GVHD (skin: Stage 1, liver: Stage 0, gut: Stage 3) that was well controlled with immunosuppressive therapies. At day 200 of transplantation, he was in complete remission with no signs of chronic GVHD. Our case suggests that non-TCD HLA-haploidentical 3-loci mismatched BMT can be safely performed from mother to offspring even when feto-maternal microchimerism is barely detectable with the current detection procedure.

Published 6 May 2005 in Eur J Haematol, 74(6): 529-32.
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