Outcome of Cyclophosphamide Treatment Following Hematopoietic Stem Cell Transplantation in a Thalassemia Patient: A Case Study

• Published in: Iranian journal of immunology Vol. 21; no. 2; p. 176
• Main Authors: M Bahlol, Heba, M Khalil, Sohaila, R El-Shanshory, Mohamed, L Salem, Mohamed
• Format: Journal Article
• Language: English
• Published: Iran Shiraz Institute for Cancer Research 30-06-2024
• Subjects: beta-Thalassemia - diagnosis; beta-Thalassemia - therapy; Bilirubin; Biomarkers; Blood diseases; Case studies; CD11b antigen; CD34 antigen; Child; Cyclophosphamide; Cyclophosphamide - therapeutic use; Diarrhea; Female; Graft vs Host Disease - diagnosis; Graft vs Host Disease - etiology; Graft-versus-host reaction; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Immunosuppressive Agents - therapeutic use; Interleukin 22; Leukocytes (granulocytic); Phenotypes; Stem cell transplantation; Thalassemia; Treatment Outcome; Cyclophosphamide; GVHD; B-thalassemia; Granulocytes; HSCT
• ISSN: 1735-1383; 1735-367X; 1735-367X
• DOI: 10.22034/iji.2024.101584.2752

Hematopoietic stem cell transplantation (HSCT) is the only curative therapy for β-thalassemia major in children. However, it often induces graft-versus-host-disease (GVHD), which is associated with complications. In the present study, we used cyclophosphamide (Cy) to treat a thalassemia patient post-HSCT to reduce the adverse effects of GVHD. We monitored the numbers and phenotype of granulocytes. In this case study, an 11-year-old female patient, diagnosed with β-thalassemia major (Pesaro class II), was treated with Cy before and after HSCT with mobilized CD34+ cells. Both the relative and absolute granulocyte counts, as well as CD33+CD11b+ cell counts, increased significantly after HSCT until day 56. However, they suddenly began to decrease after day 56, accompanied by severe diarrhea, skin rash, and a decrease in bilirubin levels compared to day -12. Furthermore, compared to day -12, IL-22 levels increased until day 56, and then decreased, while IDO levels continued to rise after day 56. Our data suggest the potential use of IL-22 and IDO as biomarkers for GVHD assessment. It also indicates that Cy promotes HSCT reconstitution by increasing CD33+CD11b+ cells, which may play a crucial role in reducing GVHD risks. However, further studies are needed to elucidate the mechanism behind GVHD recurrence.