Serial transplantation of mismatched donor hematopoietic cells between HLA-identical sibling pairs with congenital immunodeficiency: in vivo tolerance permits rapid immune reconstitution following T-replete transplantation without GVHD in the secondary recipient

Immunological reconstitution in a patient with ZAP-70 deficiency following transfusion of blood lymphocytes from a previously transplanted sibling without conditioning

“…[2][3][4] In the setting described here, stem cell donation by the older brother was not possible because of his critical liver disease. The imitation of a matched sibling graft by the combination of two cell sources provided a chance to establish immune functions without conditioning and with a low risk of inducing GvHD.…”

Domino donor lymphocyte infusion for secondary poor graft function after HLA‐mismatched allogeneic stem cell transplantation between HLA‐identical sibling pairs with congenital immunodeficiency

“…As successful serial transplantation of mismatched donor between HLA‐identical sibling pairs with congenital immunodeficiency by the “tolerized” graft has been reported, 4 our case suggests that the “tolerized” domino donor lymphocyte can lead to sufficient hematological recovery in patients with mild GvHD.…”

“…We report a successful treatment with domino DLI for poor graft function in a younger brother with hyper IgM (HIGM) syndrome from HLA‐identical elder brother with the same disorder with a history of HLA‐mismatched unrelated bone marrow transplantation (BMT) using the same donor. Successful serial transplantation in brothers with X‐linked primary immunodeficiencies has been described previously, where the recipient of HLA‐mismatched donor cells act as a functionally “HLA‐matched” donor for subsequent affected siblings 4 …”

Ethical considerations of using a single minor donor for three bone marrow harvests for three HLA‐matched siblings with primary immunodeficiency

“…These additional risks of unrelated donor transplantation were felt to not outweigh the benefits. Perform a secondary transplant from the first patient once he was two years out from transplant, because he would be expected to have healthy, disease‐free, donor‐derived hematopoietic cells in his blood and marrow. There is uncertainty regarding this option because of the lack of sufficient data for long‐term efficacy of this approach and lack of any reports of such treatment in patients with CGD . In addition, the child had been in a patient role for an extended period of time, and there was concern about adding the additional burden of bone marrow donation to his experience. Do not transplant at all.…”

“…There is uncertainty regarding this option because of the lack of sufficient data for long-term efficacy of this approach and lack of any reports of such treatment in patients with CGD. [20][21][22] In addition, the child had been in a patient role for an extended period of time, and there was concern about adding the additional burden of bone marrow donation to his experience.…”