Primary graft failure following unrelated cord blood transplantation with high-dose of CD34⁺ cells in the treatment of AML/MDS

  Objective   To analysis the cause of primary graft failure of unrelated cord blood transplantation with high-dose of CD34⁺ cells in treatment of acute myelocytic leukemia(AML)/myelodysplastic syndrome (MDS).

  Methods   A 4-year-old girl was diagnosed AML/MDS at the Department of Pediatric Hematology and Oncology of West China Second University Hospital of Sichuan University. She presented completely remission after induction and consolidation chemotherapy. She received unrelated partially human leukocyte antigen(HLA)-mismatched cord blood transplantation. We investigated the treatment outcomes of UCBT and associated complications.

  Results   The patient suffered primary graft failure and then received secondary haploidentical hematopoietic stem cell transplantation(HSCT) from her mother. However, she suffered fatal multiresistant Acinetobacter spp septicemia. She died due to respiratory failure on 7 d after the second transplantation.

  Conclusions   In this case, hematopoietic stem cells with high dose of CD34⁺ cells could not overcome the risk of primary graft failure and HLA disparity. The patient's primary graft failure was associated with platelet transfusion refractoriness and potent immunologic dysfunction, especially the anti-HLA donor specific antibodies before unrelated cord blood transplantation.