Abstract
A 24-year-old male with acute myeloid leukemia was admitted to our hospital in December 2001. After undergoing induction chemotherapy, he achieved a complete remission. He then received three courses of consolidation chemotherapy, and was discharged in May 2002. He relapsed in January 2003, and was given two courses of induction chemotherapy ; he achieved complete remission once again.
We searched for an HLA-matched donor, but none could be found either among his family or in the Bone Marrow Bank. An unrelated umbilical blood unit with a sufficient number of nucleated cells could not be found. The nested polymerase chain reaction with sequence-specific primer (PCR-SSP) typing demonstrated the presence of inherited paternal antigens (IPA) in the mother's peripheral whole blood. After considering the phenomenon of feto-maternal immunological tolerance, we decided to perform a haplo-identical allogeneic peripheral blood stem cell transplant. The patient underwent conditioning with total body irradiation (TBI) and treatment with cyclophosphamide (CY). For graft versus host disease (GVHD) prophylaxis, he was given tacrolimus and methotrexate. The infused CD34-positive cells provided 3.1×10 (6) cells per kg. The patient and his mother had a three-loci HLA mismatch. Engraftment was obtained on post-transplant day 12, and acute GVHD grade3 (skin, stage3 ; liver, stage 3 ; gut, stage 3) occurred on the same day.
He developed aspergillus pneumonia on day 195, and Carinii pneumonia on day 293, but he improved with treatment. He is currently doing well, with only mild chronic GVHD of the skin and mouth nineteen months after undergoing the stem cell transplant.
