Cargando…

Case report: Rare persistent complete donor chimerism and GVHD following micro-transplantation from HLA haplotype homozygous donors

HLA-mismatched hematopoietic stem cell micro-transplantation (MST) is an effective treatment for older patients (≥60 years) with acute myeloid leukemia. Donor selection for MST is broad, ranging from HLA fully mismatched unrelated donors to HLA partially matched related donors. However, the influenc...

Descripción completa

Detalles Bibliográficos
Autores principales: Liu, Lingling, Cui, Qingya, Li, Mengyun, Li, Zheng, Chen, Sifan, Ma, Yunju, He, Jun, Wu, Depei, Tang, Xiaowen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9521673/
https://www.ncbi.nlm.nih.gov/pubmed/36189257
http://dx.doi.org/10.3389/fimmu.2022.1005364
_version_ 1784799891703201792
author Liu, Lingling
Cui, Qingya
Li, Mengyun
Li, Zheng
Chen, Sifan
Ma, Yunju
He, Jun
Wu, Depei
Tang, Xiaowen
author_facet Liu, Lingling
Cui, Qingya
Li, Mengyun
Li, Zheng
Chen, Sifan
Ma, Yunju
He, Jun
Wu, Depei
Tang, Xiaowen
author_sort Liu, Lingling
collection PubMed
description HLA-mismatched hematopoietic stem cell micro-transplantation (MST) is an effective treatment for older patients (≥60 years) with acute myeloid leukemia. Donor selection for MST is broad, ranging from HLA fully mismatched unrelated donors to HLA partially matched related donors. However, the influence of HLA haplotype homozygous donors such donors on MST has not been studied. Such donors has been reported to be associated with a higher risk of graft-versus-host disease (GVHD) in transfusion and cord blood transplantation (CBT). Additionally, sustained complete donor chimerism is rare in MST and usually accompanied by severe acute GVHD and death. Herein, we report the first case of MST using an HLA haplotype homozygous donor. The patient developed persistent complete donor chimerism (donor cells>95%) for 7 months and prolonged isolated thrombocytopenia (PT) for 3 months, after receiving MST from his HLA homozygous son. Grade I acute GVHD presented on day 12 post-MST and it was controlled by timely immunosuppressive treatment. Then he maintained complete molecular remission, complete donor chimerism and mild GVHD for 5 months. However, moderate overlapping GVHD with skin, oral, eyes, and intestinal involvement developed after he self-discontinued Tacrolimus treatment. Fortunately, the GVHD was controlled after intensive anti-rejection therapy and Tacrolimus is now being continued for prophylaxis. This case underscores that HLA haplotype homozygous donors might not be a good choice for MST and GVHD prophylactic should be administrated if such donors have to be selected.
format Online
Article
Text
id pubmed-9521673
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-95216732022-09-30 Case report: Rare persistent complete donor chimerism and GVHD following micro-transplantation from HLA haplotype homozygous donors Liu, Lingling Cui, Qingya Li, Mengyun Li, Zheng Chen, Sifan Ma, Yunju He, Jun Wu, Depei Tang, Xiaowen Front Immunol Immunology HLA-mismatched hematopoietic stem cell micro-transplantation (MST) is an effective treatment for older patients (≥60 years) with acute myeloid leukemia. Donor selection for MST is broad, ranging from HLA fully mismatched unrelated donors to HLA partially matched related donors. However, the influence of HLA haplotype homozygous donors such donors on MST has not been studied. Such donors has been reported to be associated with a higher risk of graft-versus-host disease (GVHD) in transfusion and cord blood transplantation (CBT). Additionally, sustained complete donor chimerism is rare in MST and usually accompanied by severe acute GVHD and death. Herein, we report the first case of MST using an HLA haplotype homozygous donor. The patient developed persistent complete donor chimerism (donor cells>95%) for 7 months and prolonged isolated thrombocytopenia (PT) for 3 months, after receiving MST from his HLA homozygous son. Grade I acute GVHD presented on day 12 post-MST and it was controlled by timely immunosuppressive treatment. Then he maintained complete molecular remission, complete donor chimerism and mild GVHD for 5 months. However, moderate overlapping GVHD with skin, oral, eyes, and intestinal involvement developed after he self-discontinued Tacrolimus treatment. Fortunately, the GVHD was controlled after intensive anti-rejection therapy and Tacrolimus is now being continued for prophylaxis. This case underscores that HLA haplotype homozygous donors might not be a good choice for MST and GVHD prophylactic should be administrated if such donors have to be selected. Frontiers Media S.A. 2022-09-15 /pmc/articles/PMC9521673/ /pubmed/36189257 http://dx.doi.org/10.3389/fimmu.2022.1005364 Text en Copyright © 2022 Liu, Cui, Li, Li, Chen, Ma, He, Wu and Tang https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Liu, Lingling
Cui, Qingya
Li, Mengyun
Li, Zheng
Chen, Sifan
Ma, Yunju
He, Jun
Wu, Depei
Tang, Xiaowen
Case report: Rare persistent complete donor chimerism and GVHD following micro-transplantation from HLA haplotype homozygous donors
title Case report: Rare persistent complete donor chimerism and GVHD following micro-transplantation from HLA haplotype homozygous donors
title_full Case report: Rare persistent complete donor chimerism and GVHD following micro-transplantation from HLA haplotype homozygous donors
title_fullStr Case report: Rare persistent complete donor chimerism and GVHD following micro-transplantation from HLA haplotype homozygous donors
title_full_unstemmed Case report: Rare persistent complete donor chimerism and GVHD following micro-transplantation from HLA haplotype homozygous donors
title_short Case report: Rare persistent complete donor chimerism and GVHD following micro-transplantation from HLA haplotype homozygous donors
title_sort case report: rare persistent complete donor chimerism and gvhd following micro-transplantation from hla haplotype homozygous donors
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9521673/
https://www.ncbi.nlm.nih.gov/pubmed/36189257
http://dx.doi.org/10.3389/fimmu.2022.1005364
work_keys_str_mv AT liulingling casereportrarepersistentcompletedonorchimerismandgvhdfollowingmicrotransplantationfromhlahaplotypehomozygousdonors
AT cuiqingya casereportrarepersistentcompletedonorchimerismandgvhdfollowingmicrotransplantationfromhlahaplotypehomozygousdonors
AT limengyun casereportrarepersistentcompletedonorchimerismandgvhdfollowingmicrotransplantationfromhlahaplotypehomozygousdonors
AT lizheng casereportrarepersistentcompletedonorchimerismandgvhdfollowingmicrotransplantationfromhlahaplotypehomozygousdonors
AT chensifan casereportrarepersistentcompletedonorchimerismandgvhdfollowingmicrotransplantationfromhlahaplotypehomozygousdonors
AT mayunju casereportrarepersistentcompletedonorchimerismandgvhdfollowingmicrotransplantationfromhlahaplotypehomozygousdonors
AT hejun casereportrarepersistentcompletedonorchimerismandgvhdfollowingmicrotransplantationfromhlahaplotypehomozygousdonors
AT wudepei casereportrarepersistentcompletedonorchimerismandgvhdfollowingmicrotransplantationfromhlahaplotypehomozygousdonors
AT tangxiaowen casereportrarepersistentcompletedonorchimerismandgvhdfollowingmicrotransplantationfromhlahaplotypehomozygousdonors