Case Report: Low-dose donor lymphocyte infusion for secondary poor graft function after haploidentical HSCT in a child with β-thalassemia
- 1Department of Hematology and Oncology, Shenzhen Children’s Hospital
- 2Department of Laboratory Medicine, Shenzhen Children’s Hospital
Abstract
Poor graft function (PGF) is a serious complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), particularly when persistent cytopenia occurs despite complete donor chimerism. We report a 5-year-old girl with transfusion-dependent β-thalassemia major who developed refractory secondary PGF after haploidentical allo-HSCT following cytomegalovirus reactivation. Bone marrow was markedly hypocellular, and and multilineage cytopenias progressively worsened after plasma CMV DNA became undetectable and antiviral therapy was completed. Contributions from infection-related injury, antiviral-associated myelotoxicity, or endothelial injury could not be fully excluded. Multiple supportive and immunomodulatory interventions failed. Because a CD34 ⁺ selected stem cell boost was not feasible, the patient received intentionally low-dose donor lymphocyte infusion (DLI) on days +270 and +284. Multilineage hematopoietic recovery occurred 27 days after the first infusion, and transfusion independence was maintained for more than 14 months. Post-DLI events included manageable grade I cutaneous graft-versus-host disease and transient tachypnea of uncertain etiology. Longitudinal immune profiling showed recovery of naive T-cell compartments, contraction of effector-memory subsets, and expansion of CD8 ⁺ CD28 ⁻ T cells without overt T-cell activation. This observation provides a hypothesis-generating rationale for prospective studies evaluating the efficacy and safety of low-dose DLI in pediatric secondary PGF.
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BibTeX
@article{li2026case,
title = {{Case Report: Low-dose donor lymphocyte infusion for secondary poor graft function after haploidentical HSCT in a child with β-thalassemia}},
author = {Yue Li and Liping Luo and Dingzhi Heng and Chunjing Wang and Xiaohui Zhou and Xiaoying Fu and Sixi Liu},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1972748},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1972748/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Low-dose donor lymphocyte infusion for secondary poor graft function after haploidentical HSCT in a child with β-thalassemia
AU - Yue Li
AU - Liping Luo
AU - Dingzhi Heng
AU - Chunjing Wang
AU - Xiaohui Zhou
AU - Xiaoying Fu
AU - Sixi Liu
PY - 2026
DA - 2026/10/23
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1972748
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1972748/full
AB - Poor graft function (PGF) is a serious complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), particularly when persistent cytopenia occurs despite complete donor chimerism. We report a 5-year-old girl with transfusion-dependent β-thalassemia major who developed refractory secondary PGF after haploidentical allo-HSCT following cytomegalovirus reactivation. Bone marrow was markedly hypocellular, and and multilineage cytopenias progressively worsened after plasma CMV DNA became undetectable and antiviral therapy was completed. Contributions from infection-related injury, antiviral-associated myelotoxicity, or endothelial injury could not be fully excluded. Multiple supportive and immunomodulatory interventions failed. Because a CD34 ⁺ selected stem cell boost was not feasible, the patient received intentionally low-dose donor lymphocyte infusion (DLI) on days +270 and +284. Multilineage hematopoietic recovery occurred 27 days after the first infusion, and transfusion independence was maintained for more than 14 months. Post-DLI events included manageable grade I cutaneous graft-versus-host disease and transient tachypnea of uncertain etiology. Longitudinal immune profiling showed recovery of naive T-cell compartments, contraction of effector-memory subsets, and expansion of CD8 ⁺ CD28 ⁻ T cells without overt T-cell activation. This observation provides a hypothesis-generating rationale for prospective studies evaluating the efficacy and safety of low-dose DLI in pediatric secondary PGF.
SN - 1664-3224
ER -