Yeungnam Univ J Med.  2019 May;36(2):148-151. 10.12701/yujm.2019.00038.

Successful engraftment after infusion of multiple low doses of CD34+ cells from a poorly matched sibling donor in a patient with severe aplastic anemia

• Kum CD
• Lee MJ
• Park JE

• KMID: 2449328
• DOI: http://doi.org/10.12701/yujm.2019.00038

Abstract

The dose of CD34+ cells is known to influence the outcome of allogeneic peripheral blood stem cell (PBSC) and/or T-cell-depleted transplantation. A previous study proposed that 2×10⁶ CD34+ cells/kg is the ideal minimum dose for allogeneic transplantation, although lower doses did not preclude successful therapy. In the case we present here, CD34+ cells were collected from a matched sibling donor on the day of allogeneic hematopoietic stem cell transplantation; however, the number of cells was not sufficient for transplantation. Consequently, PBSCs were collected three additional times and were infused along with cord blood cells from the donor that were cryopreserved at birth. The cumulative dose of total nuclear cells and CD34+ cells was 15.9×10⁸ cells/kg and 0.95×10⁶ cells/kg, respectively. White blood cells from this patient were engrafted on day 12. In summary, we report successful engraftment after infusion of multiple low doses of CD34+ cells in a patient with severe aplastic anemia.

Keyword

Aplastic anemia; CD34; Cord blood stem cell transplantation; Peripheral blood stem cell transplantation

MeSH Terms

Anemia, Aplastic*
Cord Blood Stem Cell Transplantation
Fetal Blood
Hematopoietic Stem Cell Transplantation
Humans
Leukocytes
Parturition
Peripheral Blood Stem Cell Transplantation
Siblings*
Stem Cells
Tissue Donors*
Transplantation, Homologous

Reference

References

1. Peinemann F, Grouven U, Kröger N, Pittler M, Zschorlich B, Lange S. Unrelated donor stem cell transplantation in acquired severe aplastic anemia: a systematic review. Haematologica. 2009; 94:1732–42.

2. Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006; 354:1813–26.

3. Bacigalupo A. Guidelines for the treatment of severe aplastic anemia. Working Party on Severe Aplastic Anemia (WPSAA) of the European Group of Bone Marrow Transplantation (EBMT). Haematologica. 1994; 79:438–44.

4. Young NS, Barrett AJ. The treatment of severe acquired aplastic anemia. Blood. 1995; 85:3367–77.

5. Charbonnier A, Sainty D, Faucher C, Arnoulet C, Chabannon C, Blaise D. Immune reconstitution after blood cell transplantation. Hematol Cell Ther. 1997; 39:261–4.

6. Bittencourt H, Rocha V, Chevret S, Socié G, Espérou H, Devergie A, et al. Association of CD34 cell dose with hematopoietic recovery, infections, and other outcomes after HLA-identical sibling bone marrow transplantation. Blood. 2002; 99:2726–33.

7. Singhal S, Powles R, Treleaven J, Kulkarni S, Sirohi B, Horton C, et al. A low CD34+ cell dose results in higher mortality and poorer survival after blood or marrow stem cell transplantation from HLA-identical siblings: should 2 x 10(6) CD34+ cells/kg be considered the minimum threshold? Bone Marrow Transplant. 2000; 26:489–96.

8. Bacigalupo A. How I treat acquired aplastic anemia. Blood. 2017; 129:1428–36.

9. Barone A, Lucarelli A, Onofrillo D, Verzegnassi F, Bonanomi S, Cesaro S, et al. Diagnosis and management of acquired aplastic anemia in childhood. Guidelines from the Marrow Failure Study Group of the Pediatric Haemato-Oncology Italian Association (AIEOP). Blood Cells Mol Dis. 2015; 55:40–7.

10. Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hill A, et al. Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol. 2016; 172:187–207.

11. Islam MS, Anoop P, Datta-Nemdharry P, Sage D, Gordon-Smith EC, Turner D, et al. Implications of CD34+ cell dose on clinical and haematological outcome of allo-SCT for acquired aplastic anaemia. Bone Marrow Transplant. 2010; 45:886–94.

12. Pérez-Simón JA, Caballero MD, Corral M, Nieto MJ, Orfao A, Vazquez L, et al. Minimal number of circulating CD34+ cells to ensure successful leukapheresis and engraftment in autologous peripheral blood progenitor cell transplantation. Transfusion. 1998; 38:385–91.

13. Perez-Simon JA, Diez-Campelo M, Martino R, Sureda A, Caballero D, Canizo C, et al. Impact of CD34+ cell dose on the outcome of patients undergoing reduced-intensity-conditioning allogeneic peripheral blood stem cell transplantation. Blood. 2003; 102:1108–13.

14. de la Rubia J, Cantero S, Sanz GF, Remigia MJ, Monteagudo E, Moscardó F, et al. Transplantation of CD34+ selected peripheral blood to HLA-identical sibling patients with aplastic anaemia: results from a single institution. Bone Marrow Transplant. 2005; 36:325–9.

15. Le Blanc K, Samuelsson H, Gustafsson B, Remberger M, Sundberg B, Arvidson J, et al. Transplantation of mesenchymal stem cells to enhance engraftment of hematopoietic stem cells. Leukemia. 2007; 21:1733–8.