Double Syngeneic Transplantation with Bone Marrow and Peripheral Blood Stem Cells for a Child with Relapsed Acute Lymphoblastic Leukemia with the t (4;11) (q21;23)

Abstract

A 14-year-old boy with acute lymphoblastic leukemia with t (4;11) (q21;q23), relapsed in the marrow while on therapy after 8 months of complete remission, and received double syngeneic transplantation. First, for the purpose of induction, he received preconditioning with BU+VP-16+ CY and transplanted a half of the harvested marrow cells ; the other half was cryopreserved for the second transplant. Thirty days after the first transplant, he entered remission and on 65 days restarted maintenance therapy (PSL+VCR+6-MP+MTX).Six months after the first transplant, he received preconditioning with TBI+L-PAM and the second transplantation. The cryopreseved marrow and peripheral blood mononuclear cells collected after the administration of recombinant human granulocyte colony-stimulating factor (G-CSF) to the donor were transfused together for earlier blood cell recovery and escaping from complications. Currently, he has been surviving disease-free for 10 months without maintenance therapy. In conclusion, double transplantation may be an effective strategy for refractory poor prognosis leukemia, and transplantation with peripheral blood mononuclear cells collected after the administration of G-CSF to the donor may be useful.