Persistent Mixed Donor Chimerism following Double Umbilical Cord Transplantation in a Patient with T-Cell Prolymphocytic Leukemia

Abstract

T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive postthymic T-cell neoplasm with an associated survival time of 1 year when left untreated. Current standard of care for T-PLL is with alemtuzumab, followed by allogeneic or autologous stem cell transplant. Little is found in the literature about alternative donor transplantation in T-PLL. Here, we present the case of a patient treated with double umbilical cord blood transplantation, which resulted in initial complete remission. An unusual outcome of this case is that coengraftment of both cords was established. After 16 months, the patient had relapse of the disease, unfortunately, prompting treatment with alemtuzumab and pentostatin, which resulted in remission once again. Here, we report a unique phenomenon whereby single-cord dominance occurred after treatment with these agents, suggesting that anti-T-cell therapy after transplant may help achieve single-unit dominance. A second relapse of the disease occurred six months thereafter, ultimately resulting in the patient’s death, highlighting the aggressive nature of this disease.

Blood type change identifies late dominance reversal of chimerism after double umbilical cord blood transplantation with review of the literature

“…Donor 1 predominated on all testing from day +35 to 21 months post‐transplantation, ranging from 48% to 95% in chimerism studies performed on peripheral blood. The patient expired after relapse of her leukemia 17 . A review by Hashem details multiple studies addressing mixed‐unit chimerism, and Gutman details an additional 3 patients, 1 with mixed‐chimerism recorded at day +313 without disease relapse 18,19 …”

“…The patient expired after relapse of her leukemia. 17 A review by Hashem details multiple studies addressing mixedunit chimerism, and Gutman details an additional 3 patients, 1 with mixed-chimerism recorded at day +313 without disease relapse. 18,19 An example of long-term mixed-unit chimerism without close HLA-matching of the cords was reported in a 21-year-old female diagnosed with PML-RARA (15;17) translocation acute promyelocytic leukemia.…”

Haploidentical Stem Cell Transplantation Using Post-Transplant Cyclophosphamide for T-Cell Prolymphocytic Leukemia after Alemtuzumab Induction Therapy: A Case Report

“…Moreover, PTCy-based GVHD prophylaxis was associated with less chronic GVHD than calcineurin inhibitor-based GVHD prophylaxis [4]. As for UCB transplants, three cases have been reported; 1 patient reportedly died of fatal adenovirus encephalomyeloradiculitis [7][8][9]. Compared to haplo-SCT with PTCy, UCB transplantation is associated with slow hematopoietic recovery and high rates of NRM, including infection-related mortality [3].…”