First Report of Autologous Cord Blood Transplantation in the Treatment of a Child With Leukemia

We present the case of a 3-year-old girl with acute lymphoblastic leukemia who developed isolated central nervous system relapse while receiving chemotherapy 10 months after diagnosis. The child achieved a second remission on retreatment with systemic and intrathecal chemotherapy. She then underwent myeloablative chemotherapy and radiation therapy followed by infusion of her own umbilical cord blood, which the parents had saved after her delivery. She is now doing well and is in complete remission 20 months after cord blood transplantation. In this first report of autologous cord blood transplantation for treatment of childhood leukemia, we discuss the safety and feasibility of this procedure as well as some of the uncertainties surrounding autologous cord blood collection and usage. D ESPITE THE IMPROVEMENT of survival in childhood acute lymphoblastic leukemia (ALL), relapse in the central nervous system (CNS) remains a challenging problem. Early CNS relapse carries a high risk of additional relapses, especially in the bone marrow, indicating the need for intensive systemic therapy, which may include hematopoietic stem cell (HSC) transplantation. Given its wide availability, easy collection, and rich and potent HSC content, umbilical cord blood (UCB) has been identified as a good source for HSC transplantation. Allogeneic UCB, mostly from UCB banks, has been widely used as a source of HSCs to provide transplants for children with relapsed leukemia. The use of autologous cord blood (when available) for HSC transplantation is a challenging and controversial matter. In addition to the rare availability of autologous cord blood, there is a concern that it may contain the leukemic clone that progressed to cause the child’s leukemia. In this report we describe a case of autologous cord blood transplantation for treatment of relapsed ALL and discuss the feasibility and safety of such a procedure.