Hematopoietic stem cell transplant for hyper-IgM syndrome due to CD40L defects: A single-center experience

Pediatr Transplant. 2015 Sep;19(6):634-9. doi: 10.1111/petr.12538. Epub 2015 Jun 13.

Abstract

HIGMI is a disease with a high risk for morbidity and mortality. HSCT has been shown to be a curative option. This study retrospectively reviewed and analyzed data from five patients who received HSCT at King Faisal Specialist Hospital & Research Centre (KFSH&RC) in Riyadh, Saudi Arabia, between 2005 and 2013. Five patients with HIGMI syndrome underwent HSCT at a median age of 41 months (range, 9-72 months). The median time from diagnosis to transplantation was 30 months (range, 5-58 months). For all five patients, the donors were HLA-identical siblings. In three patients, the conditioning regimen was composed of BU and CY. Fludarabine and melphalan with either ATG or alemtuzumab was used in two patients. For GVHD prophylaxis, cyclosporine was used in two patients, and the combination of cyclosporine and MTX was used in three patients. The survival rate was 100%, with a median follow-up of 69 months (range, 13-100 months). All patients engrafted. Two patients developed acute GVHD. Four patients showed complete immune recovery with positive CD40L expression in activated T cells and discontinued IVIG replacement. HSCT in early stage from an HLA-matched sibling donor is potentially effective at curing the disease.

Keywords: cryptosporidium; neutropenia; primary immunodeficiency; stems cell transplantation.

Publication types

  • Evaluation Study

MeSH terms

  • CD40 Ligand / genetics
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Genetic Markers
  • Graft vs Host Disease
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Hyper-IgM Immunodeficiency Syndrome, Type 1 / diagnosis
  • Hyper-IgM Immunodeficiency Syndrome, Type 1 / genetics
  • Hyper-IgM Immunodeficiency Syndrome, Type 1 / mortality
  • Hyper-IgM Immunodeficiency Syndrome, Type 1 / therapy*
  • Infant
  • Male
  • Retrospective Studies
  • Transplantation Conditioning
  • Treatment Outcome

Substances

  • Genetic Markers
  • CD40 Ligand