Background: Approximately 5%-37% of patients develop persistent thrombocytopenia following hematopoietic stem cell transplantation (HSCT). One of therapy is donor lymphocyte infusions (DLI). But in cord blood (CB) transplant (CBT), DLI is difficult because of donor lymphocytes unavailable. We hypothesized peripheral lymphocytes collected early phase (PLCEP) in CBT still retain allo-reaction and may be used as cell source for DLI. Here, we reported the first case with PLCEP-DLI.
Objective: To prove the effect of PLCEP-DLI.
Methods: Lymphocytes were collected in early phase in CBT as DLI cell source, and the DLI was given when the patient has thrombocytopenia.
Case report: A 2 year old boy, with body weigh of14.8kg, was diagnosed with thalassemia major at the age of 8 months, and then, began to receive regular infusion. He received dual HSCT from haploidentical donor combined with matched CB in August 2021, with conditioning regimen comprised of BU+CY+TT+Flu+ATG. CB stably engrafted finally.
At day 685 after HSCT, the patient was re-admitted due to “subcutaneous hemorrhagic spot for 2 weeks”. The routine blood test showed that neutrophils were 5.69*10e9/L, hemoglobin 112g/L, and platelets 2*10e9/L. Cells in peripheral blood (PB) sourced from cord blood in 100%. Anti-platelet and anti-HLA antibodies were positive (4+), with 0.4% red cell fragments and rare platelets on PB smear. Scanning of viruses, such as CMV, EBV, ADV, and B19 was negative. Direct and indirect Coomb's tests were negative.
Immune thrombocytopenia was diagnosed and drugs (IVIg, steroid, Rituximab Eltrombopag, and intravenous TPO) were given. In spite of short respondence and negative anti-platelet and anti-HLA antibodies, platelets were still low (1-8*10e9/L) along with hyperplasia marrow and 110 megakaryocytes on bone marrow smear. On day 700 after transplant, the patient received PLCEP-DLI with CD3+ cells of 4.94*10e6/kg following lymphocyte-depleted therapy of Flu (30mg/ m2 *3d) and CY (200mg/ m2 *1d) and immunosuppressant discontinuation.
On day 6 after DLI, skin rash appeared and disappeared after Ruxolitinib. The platelets recovered to 20, 50 and 123*10e9/L on day 9, 20, and 27, respectively. Up to June 30, 2024 (1048 days after HCT), the platelet was normal.
Summary: The case showed PLCEP-DLI was effect. which could effectively correct the immune thrombocytopenia in post-CBT. Allo-reactable lymphocytes collected early phase in CBT can be used as cell source for post-CBT DLI, however, the result of the case need to be proved in more cases in the future.
No relevant conflicts of interest to declare.
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