Umbilical Cord Blood Infusion in Addition to Immunosuppressive Therapy in a Patient with Relapsed and Refractory Severe Aplastic Anemia

Review Article

Ann Hematol Oncol. 2016; 3(10): 1117.

Umbilical Cord Blood Infusion in Addition to Immunosuppressive Therapy in a Patient with Relapsed and Refractory Severe Aplastic Anemia

Xiu L, Huina L, Bing X, Aibin L and Yi Ding*

Department of Hematology, Tongji University School of Medicine, China

*Corresponding author: Yi Ding, Department of Hematology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, China

Received: September 07, 2016; Accepted: October 18, 2016; Published: October 21, 2016


Background: Acquired severe aplastic anemia is a life-threatening bone marrow failure disorder characterized by pancytopenia and a hypocellular bone marrow. The optimal therapeutic strategies for SAA remain challenging in clinical settings. Here, we reported the use of umbilical cord blood infusion in a relapsed and refractory case of SAA.

Case Presentation: A 25 year-old patient was not able to receive allogenic hematopoietic stem cell transplantation from HLA identical sibling donors and was relapsed to common immunosuppressive therapy. We applied the IST plus UCBI remedy for this patient. Interestingly, the patient achieved not only complete recovery of hemopoietic function and hemogram indexes but also successful engraftment of stem cells into the bone marrow.

Conclusions: We suggest that IST plus UCBI may be a safe and effective remedy for patients with relapsed and refractory SAA.

Keywords: Severe aplastic anemia; Umbilical cord blood infusion; Immunosuppressive therapy


Acquired Severe Aplastic Anemia (SAA) is one of the most serious and complicated hematological disorders [1]. For young SAA patients who are not able to receive allo-HSCT, combined Immunosuppressive Therapy (IST) is the first-line conditioning regimen [2-4]. However, still up to 20-40% of SAA patients can’t obtain hematologic remission from IST or resist to IST [5,6]. It remains challenging to optimize treatment for these refractory SAA patients [7-10]. Recently emerged evidences have demonstrated that Umbilical Cord Blood Infusion (UCBI) in addition to common IST remedy provide additional benefits in treating SAA [11]. Herein, we report the successful use of Umbilical Cord Blood (UCB) in a young patient with relapsed and refractory SAA.

Case Presentation

A 25 year-old female who presented with dizziness and fatigue over the prior 4 months was admitted to our department. Routine Blood Examination at admission as follows: erythrocytes (RBC) count was 1.1x1012/L, Hemoglobin (Hb) count was 3.8 g/dL, reticulocyte count was 11x109/L, White Blood Cell (WBC) count was 2600/mm3, neutrophils(ANC) count was 450/mm3, and platelets(PLT) count was 4x109/L. Subsequent bone marrow examination on January 28, 2014, demonstrated extremely reduced hematopoietic tissue, severely hypoplastic bone marrow and normal chromosome karyotyping in bone marrow cells. According to the acute onset, the normal chromosome karyotyping, and the results of bone marrow biopsy and peripheral hemogram, a diagnose of SAA type I was established.

The patient failed to undergo allo-HSCT as no siblings or fully matched HLA donors were available. She received oral cyclosporine (CsA, 5 mg/kg, q12h) treatment after diagnosis. The trough concentrations of CsA were maintained between 150 and 250 ng/ ml. Intermittent composition transfusions of red blood cells, platelets and subcutaneous injection of granulocyte colony stimulating factor(Lenograstim, 5 mg/kg) were administered. However, blood values did not noticeably recover after these measures.

Since February 11, 2014, the patient received combined IST. The conditioning regimen included continuous oral CsA and 2.5 mg/kg/ day ATG from day -5 to day -1 (Figure 1A). Blood counts began to recover on April 23, 2014, with erythrocytes 2.0x1012/L, Hemoglobin 7.1g/dL, reticulocytes 86x109/L, WBC 1900/mm3, neutrophils 700/mm3, and platelets 20x109L. Blood transfusion therapy was terminated accordingly. On May 7, 2014, the peripheral hemogram indexes showed the largest improvement with erythrocytes 2.1 x 1012/L, Hemoglobin 7.3 g/dL, reticulocytes 96.6x109L, white blood cell 2200/mm3, neutrophils 1800/mm3, and platelets 36x109L (Figure 2A, B and C).