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Submitted: 24 November 2006 Modified: 24 October 2012
HERDIN Record #: PCHRD112306011120

Mismatched unrelated umbilical cord blood transplantation for pediatric acute myelogenous leukemia.

Honorata G. Baylon,
Melodyn U. Uy,
Ma Luz U. del Rosario,
Beatrice J. Tiangco

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In this report, we present a 9-year-old female with acute myelogenous leukemia who underwent transplantation using umbilical cord blood (UCB) stem cells from a one-antigen HLA-mismatched unrelated donor. Following conditioning with busulfan, cyclophosphamide and anti-thymocyte globulin, UCB was infused with a total nucleated cell dose of 3.39 x 10 exponent 7/kg Ideal body weight and the CD34+ cell dose was 2.6 x 10 exponent 5/kg ideal body weight. Delayed neutrophil and platelet engraftment were noted, comparable with data previously reported following transplantation of UCB. Engraftment analysis 36 days post-transplant was consistent with complete donor chimerism. There was no associated clinically significant graft-versus-host disease (GVHD). Bone marrow aspiration post-transplantation showed no evidence of acute myelogenous leukemia. She is currently 143 days post-transplant. This case describes our local experience with UCB transplant as a treatment option for pediatric acute myelogenous leukemia.

RATIONALE AND OBJECTIVE:: The allogeneic transplantation of hematopoietic stem cells is known to cure some patients with high-risk hematologic malignancies. However, its use is limited by the lack of HLA-matched donors and the risk of graft-versus-host disease, the complications of which become more severe with increasing HLA disparities. As a result, there continues to be a need to look for other sources of these stem cells. In 1988, a child with Fanconi anemia was successfully transplanted using umbilical cord blood from his HLA-identical sister. This case Demonstrated for the first time the ability of cord blood stem cells to repopulate a host lymphohematopoietic system. Since then, more than 2500 UCB transplants have been performed worldwide both related and unrelated donors, establishing cord blood as a viable alternative source of Hematopoietic stem cells.

Graft-versus-host disease (GVHD) on the other hand, can negatively impact overall survival and the Quality of life of patients post-transplant. Comparing with bone marrow transplantation, using UCB has also been associated with a lower incidence and severity of GVHD, even with the use of HLA-mismatched units. This report aims to demonstrate our local experience with mismatched unrelated UCB transplantation as therapy for a child with acute myelogenous leukemia. Issues specific to UCB transplants such as those pertaining to engraftment, cell dose, infections and graft-versus-host disease will be discussed. Likewise, current literature regarding the UCB in children with acute myelogenous leukemia will be reviewed. (Author)

Publication Type
Journal
Publication Sub Type
Case report
Title
Philippine Journal of Internal Medicine
Frequency
Six times a year (6x/year)
Publication Date
January-February 2006
Volume
44
Issue
1
Page(s)
41-45

Objectives

This report aims to demonstrate our local experience with mismatched unrelated umbilical cord blood transplantation as therapy for a child with acute myelogenous leukemia.

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 48 Abstract Print Format (Request Document)
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