Successful Concurrent Double Bone Marrow Transplantations For Two Beta-Thalassemia/Hemoglobin E Siblings From One Matched Unrelated Donor

Abstract

Beta-thalassemia disease is a common inherited genetic disease in Thailand. Bone marrow transplantation is worldwide acceptance to potentially cure the disease. When the affected children have no any HLA-matched siblings, they will require appropriate matched unrelated healthy donors. Thalassemias and hemoglobinopathies can affect in same immediate family members or siblings, in particular in the countries that these abnormal globin gene defects are highly prevalent among their people. Same-parent siblings have a chance to have HLA-matched to each other about 25%. The event reported here is about concurrent double allogeneic bone marrow transplantations performed simultaneously in two Thai beta-thalassemia/hemoglobin E brothers, aged 3-year-10-month and 1-year-8-month, using marrow stem cells from the same one Taiwanese matched unrelated adult donor. These brothers were fortunate to have similar HLA types and also compatible with a matched unrelated donor identified by high resolution HLA typing method. The 29-year-old Taiwanese male donor was identified and facilitated through the cooperation between National Blood Centre, Thai Red Cross Society and Buddhist Tzu Chi Stem Cell Donor Registry in Taiwan. His body weight was 90 kilogram while the patients' weights were 17 and 10 kilogram. The donor and younger boy had same blood group O Rh positive but the elder boy had group B positive. As bone marrow volume and stem cell dose being estimated beforehands, the donor was harvested his marrow in Taiwan for the sufficient amount for both patients in the morning of transplant day. The marrow then was transported by a courier flying back to Bangkok, and divided and infused to each recipient at night on the same day. Mononuclear cell doses per kilogram for elder and younger boys were 9.9 and 14.7 x108, respectively, while CD 34 positive cell doses per kilogram were 10.1 and 13.5 x106, respectively. The patients were treated in two separated HEPA-filtered rooms. Conditioning regimens used were busulfex, cyclophosphamide, fludarabine, and ATG, while ta-crolimus and methotrexate were utilized as GVHD prophylaxis. Both of recipients had neutrophil recoveries evident on day +18. They both achieved successful donor engraftment without GVHD or any serious post-transplant complications. They underwent the transplantations in August 2007 and have been regularly followed up since. To date it is more than 2 years follow-up, they are alive and very well, free of disease so far.