Graft rejection and hyperacute graft-versus-host disease in stem cell transplantation from non-inherited maternal-antigen-complementary HLA-mismatched siblings

Eur J Haematol. 2007 Feb;78(2):157-60. doi: 10.1111/j.1600-0609.2006.00797.x.

Abstract

Human leukocyte antigen (HLA)-mismatched stem cell transplantation from non-inherited maternal antigen (NIMA)-complementary donors is known to produce stable engraftment without inducing severe graft-versus-host disease (GVHD). We treated two patients with acute myeloid leukemia (AML) and one patient with severe aplastic anemia (SAA) with HLA-mismatched stem cell transplantation (SCT) from NIMA-complementary donors (NIMA-mismatched SCT). The presence of donor and recipient-derived blood cells in the peripheral blood of recipient (donor microchimerism) and donor was documented respectively by amplifying NIMA-derived DNA in two of the three patients. Graft rejection occurred in the SAA patient who was conditioned with a fludarabine-based regimen. Grade III and grade IV acute GVHD developed in patients with AML on day 8 and day 11 respectively, and became a direct cause of death in one patient. The findings suggest that intensive conditioning and immunosuppression after stem cell transplantation are needed in NIMA-mismatched SCT even if donor and recipient microchimerisms is detectable in the donor and recipient before SCT.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Anemia, Aplastic / immunology
  • Anemia, Aplastic / pathology
  • Anemia, Aplastic / surgery*
  • Blast Crisis / immunology
  • Blast Crisis / pathology
  • Blast Crisis / surgery*
  • Chimera / genetics
  • Chimera / immunology*
  • Cord Blood Stem Cell Transplantation
  • Disease Progression
  • Fatal Outcome
  • Female
  • Graft Rejection / genetics
  • Graft Rejection / immunology*
  • Graft vs Host Disease / genetics
  • Graft vs Host Disease / immunology*
  • Graft vs Host Disease / prevention & control
  • HLA Antigens / genetics*
  • HLA Antigens / immunology
  • Histocompatibility
  • Humans
  • Immunity, Maternally-Acquired*
  • Isoantigens / immunology
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / immunology
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / pathology
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / surgery*
  • Leukemia, Myeloid / drug therapy
  • Leukemia, Myeloid / pathology
  • Male
  • Peripheral Blood Stem Cell Transplantation / adverse effects*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / immunology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / pathology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / surgery*
  • Remission Induction
  • Siblings
  • Tissue Donors*
  • Transplantation Conditioning / methods*
  • Vidarabine / administration & dosage
  • Vidarabine / analogs & derivatives

Substances

  • HLA Antigens
  • Isoantigens
  • Vidarabine
  • fludarabine