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

Hirokazu Okumura, Masaki Yamaguchi, Takeharu Kotani, Naomi Sugimori, Chiharu Sugimori, Jun Ozaki, Yukio Kondo, Hirohito Yamazaki, Tatsuya Chuhjo, Akiyoshi Takami, Mikio Ueda, Shigeki Ohtake, Shinji Nakao
European Journal of Haematology 2007, 78 (2): 157-60
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.

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