MHC class II deficiency cured by unrelated mismatched umbilical cord blood transplantation: Case report and review of 68 cases in the literature

Authors


Present address: Childrens Hospital Altona Hamburg, Hamburg, GermanyTim Niehues, MD, Center for Child and Adolescent Health, HELIOS Klinikum Krefeld, Academic Hospital, Heinrich Heine University of Duesseldorf, Lutherplatz 40, 47805 Krefeld, Germany
Tel.: +49 2151 322301
Fax: +49 2151 322334
E-mail: Tim.Niehues@helios-kliniken.de

Abstract

Siepermann M, Gudowius S, Beltz K, Strier U, Feyen O, Troeger A, Göbel U, Laws HJ, Kögler G, Meisel R, Dilloo D, Niehues T. MHC class II deficiency cured by unrelated mismatched umbilical cord blood transplantation: Case report and review of 68 cases in the literature. Pediatr Transplantation 2011: 15: E80–E86. © 2010 John Wiley & Sons A/S.

Abstract:  MHC class II deficiency is a rare and fatal form of primary combined immunodeficiency caused by a lack of T-cell-dependent humoral and cellular immune response to foreign antigens, which can only be cured by allogenic stem cell transplantation. In the literature search, we identified 68 cases of HSCT in MHC class II deficiency in the last 14 yr. Pre- and post-transplant MHC class II deficiency is complicated by overwhelming viral infections, a high incidence of GvHD, and graft failure with a poor overall survival rate below 50%. We report an eight-month-old boy presenting with severe respiratory infections and chronic diarrhea, whose sister died at the age of four yr from septicemia. MHC II deficiency was caused by an RFXANK-mutation and treated successfully by 4/6 mismatched unrelated CBT after a myeloablative conditioning regimen based on anti-thymocyte globulin, busulfane, fludarabine, and cyclophosphamide. At present, our patient is well with full immune reconstitution 3inline image yr after CBT. CB may represent an alternative source of stem cells for children with MHC class II deficiency without a suitable donor.

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