Reduced-intensity conditioning in unrelated donor cord blood transplantation for familial hemophagocytic lymphohistiocytosis

Masanori Nishi, Ryosei Nishimura, Nobuhiro Suzuki, Akihisa Sawada, Takayuki Okamura, Naoto Fujita, Rie Kanai, Jun Yano, Souichi Adachi, Takahiro Yasumi, Emiko Sato, Koji Yasutomo, Eiichi Ishii, Shouichi Ohga

Research output: Contribution to journalLetterpeer-review

25 Citations (Scopus)

Abstract

Familial hemophagocytic lymphohistiocytosis (FHL) is a disorder of immune homeostasis characterized by fever, cytopenias, hepatosplenomegaly, and coagulopathy. We studied the outcomes of 13 FHL patients who underwent the first unrelated cord blood transplantation (UCBT) after non-myeloablative conditionings. The major regimen consisted of fludarabine (FLU; n = 12)+melphalan (MEL; n = 11)±low-dose total body irradiation (TBI 2-4 Gy; n = 6). The median age at presentation and period to UCBT were 6 and 5 months, respectively. Central nervous system (CNS) disease developed in one infant at diagnosis, and in two others until UCBT. HLH activity was controlled in all but one at the time of UCBT. Ten patients had early engraftment on median day 21 with no grade >2 treatment-related toxicity and two controllable grade >2 acute GVHD. Two patients with early rejection successfully underwent subsequent UCBT after myeloablative conditioning. Two others had late graft failure following mixed donor chimerism. Two deaths occurred from HLH; early liver failure and late CNS disease. Of 11 FLU+MEL-conditioned patients, the frequency of disease-free complete engraftment was higher for MEL (≥120 mg/m 2)+TBI, or high-dose MEL (180 mg/m 2) than for others (83% vs. 25%, p = 0.036). The FLU+MEL-based non-myeloablative regimen was acceptable for FHL infants undergoing UCBT, although further studies will be needed for confirmation.

Original languageEnglish
Pages (from-to)637-639
Number of pages3
JournalAmerican Journal of Hematology
Volume87
Issue number6
DOIs
Publication statusPublished - Jun 2012

All Science Journal Classification (ASJC) codes

  • Hematology

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