Double haploidentical transplantation of hematopoietic progenitor cells ina boy with myelodysplastic syndrome

A 12-year-old boy with myelodysplastic syndrome underwent a double transpla ntation of hematopoietic progenitor cells from his haploidentical brother. After conditioning with busulfan, cyclosphophamide, and Vepesid, the first bone marrow transplantation was performed using 3.53 x 10(6)/kg of CD34(+) cells, harvested from bone marrow (BM) and peripheral blood. Graft versus h ost disease (GvHD) prophylaxis consisted of cyclosporine A + short methotre xate. Hematological recovery was rapid and stable. Acute GvHD I degrees (sk in) resolved after 2 weeks of steroid treatment. A relapse occurred on day + 140. At that time NK cells decreased from 20 to 7% with the lowest CD4(+) /CD8(+) ratio, 0.07. Just after relapse, the percentage of cytokine-induced killer cells (CIK-Cd3(+)CD56(+)) dropped from 3.34 to 0.1%. CsA treatment was stopped and the patient received T cell (CD3(+) cells) add-back four ti mes on days +146, +199, +234, and +262 in doses of 0.5 x 10(5), 1.0 x 10(5) , 2.0 x 10(5), and 4.0 x 10(5)/kg, respectively. No acute GvHD occurred. Ad ditionally, bone marrow biopsy before the second add-back showed complete r emission. Analysis of lymphocyte subsets before the fourth add-back showed the highest values of CD4(+), NK, and CIK cells and also the highest CD4(+) /CD8(+) ratio.