Abstract
We report on a one-year-old girl with infantile acute lymphocytic leukemia (ALL) who received a transplant with CD34+ marrow cells from her HLA two-loci mismatched father. The CD34+ marrow cells were selected using an Isolex 50 Cell Separation SystemTM. A total of 7.25 × 106/kg CD34+ cells were infused to the patient with 1.57 × 104/kg of CD5 + cells. The conditioning regimen consisted of total body irradiation, busulfan, cyclophosphamide and anti-thymocyte globulin. Cyclosporin A (3 mg/kg) and prednisolone (1 mg/ kg) were administered for the prophylaxis of graft-versus-host disease (GVHD). White blood cell counts and reticulocyte counts increased promptly, but recovery of the platelet count was delayed. No clinical symptoms of acute GVHD were noted. A chromosomal analysis of the bone marrow cells for sex mismatch revealed complete chimerism on day + 14, but mixed chimerism on day +28. For the treatment of mixed chimerism, 1 × 106-107/ kg of the donor's lymphocytes were infused to the patient, inducing GVHD. The GVHD became uncontrollable after immunosuppressive therapies, and the patient died. Selective CD34+ marrow cell transplantation from HLA-mismatched donors may be one of the curable methods for poor-prognosis patients without available donors, however, further evaluation for mixed chimerism or relapse is needed.
