Serial transplantation resulting in tolerance to an unrelated cord blood graft

W. Scott Goebel, Robert P. Nelson, Zacharie Brahmi, Darla J. Gowan, Paula J. Towell, Kent A. Robertson, Paul R. Haut

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Unrelated cord blood (UCB) hematopoietic stem cells were serially transplanted into two human leukocyte antigen (HLA)-identical siblings with T cell, B cell, natural killer cell severe combined immunodeficiency. Brother A received a 4/6-matched, HLA DRβ1-identical but class I-disparate UCB graft after myeloablative dosages of busulfan, melphalan, and antithymocyte globulin. He experienced complete donor chimerism, severe acute gastrointestinal graft-versus-host disease (GVHD), and limited chronic skin GVHD that resolved with treatment. Two years later, brother B received unfractionated marrow from brother A after reduced-intensity conditioning with cyclophosphamide and antithymocyte globulin. Brother B experienced mixed-donor (i.e. original UCB) chimerism and no histologically documented GVHD. Both brothers are clinically well; brother A is in a fully immunologically reconstituted state. The uneventful course and progressive increase in donor chimerism after the second transplantation indicates that hematopoietic cells derived from the older brother's marrow engrafted without causing GVHD, suggesting that acquired tolerance to disparate unrelated HLA antigens was achieved.

Original languageEnglish (US)
Pages (from-to)1596-1599
Number of pages4
JournalTransplantation
Volume81
Issue number11
DOIs
StatePublished - Jun 1 2006

Keywords

  • Severe combined immunodeficiency
  • Stem cell transplantation
  • Tolerance
  • Umbilical cord blood

ASJC Scopus subject areas

  • Transplantation
  • Immunology

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