Combined Haploidentical and Umbilical Cord Blood Transplantation for Severe Aplastic Anemia: Unique Hematopoietic Reconstitution

Publication date: Available online 29 August 2018Source: Hematology/Oncology and Stem Cell TherapyAuthor(s): Anant Vatsayan, Hasan Hashem, Kristen Nagle, Linda Cabral, Hillard Lazarus, Jignesh DalalAbstractHematopoietic stem cell transplant (HSCT) with matched sibling donor (MSD) is considered the first line of therapy for patients with severe aplastic anemia (SAA) who are < 40 years of age1. Immunosuppressive therapy (IST) and alternative donor HSCT are other modalities of treatment1. Due to non- availability of a MSD for two- thirds of the SAA patients and a significant rate of failure of IST, alternative donor HSCT has been tried with encouraging results2. In 2003, Fernandez et al, in a cohort of 11 patients with high risk hematological malignancies, successfully utilized a novel approach of supplementing cord blood unit (CBU) with CD34+ cells from haplo- identical donor to use the latter as a bridge for rapid neutrophil recovery followed by a persistent dominant CBU chimerism3. In 2011, Gromley et al, pioneered the use of haplo- cord transplant for SAA patients lacking HLA compatible MSD/unrelated donor who failed IST4. Typically, hematopoietic reconstitution after haplo- cord transplant shows a pattern of transient myeloid engraftment with haploidentical graft followed by dominant CBU chimerism5. Here, we report a case of haplo- cord HSCT for SAA that showed a unique hematopoietic reconstitution kinetics. The patient was found to have a dominant CBU peripheral blood ...
Source: Hematology Oncology and Stem Cell Therapy - Category: Cancer & Oncology Source Type: research