Summary:A 15-year-old female received an unrelated three of six HLA antigen matched umbilical cord blood (UCB) transplant for refractory, relapsed T-cell ALL. Conditioning consisted of TBI, melphalan, and anti-thymocyte globulin (ATG), with cyclosporin A (CsA) and solumedrol for GVHD prophylaxis. She engrafted and a day 34 bone marrow aspirate showed 100% donor cells and no evidence of leukemia. The post-transplant course was complicated by mild grade I acute GVHD involving skin, and limited chronic GVHD of the gut which resolved with the addition of 1 mg/kg/day of steroids to her CsA prophylaxis. One hundred and ninety days after transplantation the patient developed pancytopenia and was subsequently found to have a leukemic relapse. Immunosuppression was discontinued and she was started on G-CSF and erythropoietin. Moderate skin and gut GVHD developed which was treated with both topical and low-dose oral steroids. Over the next few weeks she became transfusion independent and a follow-up bone marrow aspirate showed complete remission. She continued in complete remission for 4 months, at which time localized leukemic relapse was found in a soft tissue breast mass in spite of continued bone marrow remission. from BMT but lack a suitably matched conventional transplant donor.1-4 Preliminary results have suggested that UCB transplantation may be associated with a lower incidence of acute GVHD than unrelated bone marrow, and require less stringent HLA matching.2-4 While less GVHD is a potential benefit of UCB transplantation, there is concern that UCB may not be able to generate a sufficient GVL effect in patients with hematologic malignancies, resulting in increased relapse rates and limiting its practical utility. In this report we describe a patient who relapsed after undergoing UCB transplantation from a partially mismatched (3/6) unrelated donor for refractory relapsed T cell ALL. A complete remission was achieved following discontinuation of immunosuppression and institution of cytokine support. Whether UCB cells generate a GVL effect in all patients is unknown, but this case report clearly demonstrates that UCB has the potential to generate a GVL effect and this effect can be powerful enough to induce a complete remission. As the biology and mechanisms of GVHD and GVL are more completely understood, it may become possible to uncouple these two immune responses and maximize the benefits of hematopoietic stem cell transplantation without compromising anti-leukemic effects. Case reportA 15-year-old white female had been diagnosed with CD7 +
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