A successful cord blood transplant in a child with second accelerated phase chronic myeloid leukemia following lymphoid blast crisis

We describe a 5-year-old girl with Ph(+) CML who received a cord blood tran splant in a second accelerated phase after a very early lymphoid blast cris is, She was induced into CR by ALL-directed chemotherapy and then maintaine d with IFN-alpha 2b together with weekly rotational chemotherapy, Nineteen months after diagnosis, her mother gave birth to an HLA-compatible sibling, whose cord blood was cryopreserved, The patient's second acceleration occu rred 22 months after the CML diagnosis. The subsequent conditioning regimen included busulfan 16 mg/kg, Ara-C 12 g/m(2) and melphalan 140 mg/m(2). In order to prevent GVHD, CsA alone was administered, 3 mg/kg i.v. per day for a total of 40 days. The total number of nucleated cells infused was 0.8 x 10(8)/kg, with CD34(+) cells 1.8 x 10(6)/kg and CFU-GM 1 x 10(4)/kg, Engraf tment occurred on day +35. Respiratory distress, severe VOD and grade II ac ute gastrointestinal GVHD complicated the posttransplant period. No chronic GVHD occurred. The girl is alive 23 months after transplantation with comp lete donor chimerism; both Ph chromosome and bcr/abl RNA are negative.