This is the case of a baby girl born June 2009 and with CML BCR-ABL1 b2a2 p210 diagnosed in January 2010, at the age of 6 months. She had hepatosplenomegaly on diagnosis with a FBC Hb 6,5g/dL WBC 168x109/L and Plat 1254x109/L , BM cytogenetics 46,XX t(9;22) (q34;11.2).
Treatment was started with oral imatinib given as per the CML-pead-II-study on a dose of 50mg bd. At 3 and 6 months post-treatment RQ-PCRs were respectively 21% and 29%.
Her cord blood was cryopreserved at birth and tested negative for BCR-ABL.
She is the only child of a healthy 36-y-old couple. Although her parents are not related they share HLA antigens so that the patient is homozygotic for HLA A, B, C, DRB1 and DQB1 on high resolution typing.
She was referred for an unrelated allotransplant.
I would like to discuss whether anyone would consider an autologous graft using the cryopreserved CB, advise the parents to try a 2nd child or proceed with an unrelated transplant.
Manuel Abecasis, MD PhD
Director, BMT Program
Instituto Portugues Oncologia
Lisboa Portugal