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Shinkoda Y, Ijichi O, Tanabe T, Ishikawa S, Kamitamari A, Nishikawa T, Ikarimoto N, Kawano Y. Identical reconstitution after bone marrow transplantation in twins who received fresh and cryopreserved grafts harvested at the same time from their older brother.Clin Transplant 2004: 18: 743–747.© Blackwell Munksgaard, 2004We report here the reconstitution after bone marrow transplantation (BMT) in identical infant twins withacute myelogenous leukemia (AML). They were diagnosed at 8 and 9 months of age. Complete remission was induced after two courses of chemotherapy. After four and five courses of chemotherapy, respectively, they received BMT at 2-month interval from the same HLA-identical older brother. The total dose of marrow nucleated cells (NC) harvested was 77.7 × 108. The first patient was transplanted with half of the total dose of NC. The remaining cells were cryopreserved without the use of a programmed freezer and transplanted into the second patient 2 months later. The number of days for neutrophil (>0.5 × 109/L), platelet (>50 × 109/L), and reticulocyte (>1%) recovery were, respectively, 15, 21, and 14 in the first case and 12, 21, and 15 in the second case. The clinical courses after BMT were uneventful in both cases, except for mild acute GVHD, and complete remission has been maintained>4 yr with full recovery of immune and marrow function. Based on the results in these cases, we confirmed that marrow cells that have been cryopreserved without the use of a programmed freezer could reconstitute immune and marrow function as well as non-cryopreserved cells. [ABSTRACT FROM AUTHOR]

Langer T, Beck JD, Gravou-Apostulatou C, Lang P, Handgretinger R, Greil J. Successful treatment of primary refractory acute myeloid leukemiawith megadose stem cell transplantation, bone marrow boostand reduced intensity conditioning avoiding chronic graft vs. host disease and severe late toxicity. Pediatr Transplantation 2003: 7: 494–496. © 2003 Blackwell Munksgaard We report on a 9-yr-old boy suffering from primary refractory AML. Remission was not achieved after two courses of induction therapy, leading to prolonged aplasia for more than 3 months and severe infection. Therefore, the boy was treated with a reduced intensity conditioning regimen consisting of fludarabine, cyclophosphamide and OKT3. Megadose transplantation of highly enriched CD34+ peripheral stem cells from his HLA-identical brother, followed on day +11 by a boost of unmanipulated bone marrow, was performed. Regeneration of donor hematopoiesis was rapid and led to resolution of infection. No additional donor lymphocyte infusions were necessary. More than 4 1/2 yr after the transplant the boy remains in complete continuous remission with no evidence for chronic GvHD or other late effects. Therefore, we conclude that reduced intensity conditioning in combination with allogeneic megadose stem cell transplantation and bone marrow boost may have helped to achieve cure from primary refractory AML as well as a good quality of life for this boy. [ABSTRACT FROM AUTHOR]