Acute lymphoblastic leukemia and stem cells

Successful bone marrow stem cell transplantation for a coronavirus-positive child with acute lymphoblastic leukemia

A child of only 6 years of age suffering from acute lymphoblastic leukemia arrived in Italy from London in the autumn of 2019 to undergo a marrow transplant. At the Bambino Gesù Hospital in Rome, in the Department of Oncohaematology and Cellular and Gene Therapy, preparatory therapies of chemo and immunotherapy begin, in order to lower the “charge” of the disease to a threshold that allows the transplant to have a better chance of success, and then finally recover from leukemia.

The medical team led by Prof. Franco Locatelli decides to proceed with the transplantation of haematopoietic stem cells from a parent, in the absence of a compatible donor. In March 2020 – in the middle of the pandemic – child and parents undergo to the necessary tests to determine who will be the candidate for bone marrow donation. From the tests, the whole family tested positive for COVID-19: father and child asymptomatic, while the mother showed mild symptoms.

It was therefore decided to immediately treat the child with an infusion of hyperimmune plasma obtained from a patient already cured of the infection, recruiting the plasma donor with the best neutralizing antibodies count, i.e. able to prevent the binding of the coronavirus protein to its receptor present on human cells.

Once negative, the child was finally subjected to the transplantation of his father’s – negative, too – haematopoietic stem cells specially manipulated to eliminate alpha/beta+ T lymphocytes, cells dangerous to the recipient’s organism. It is a technique developed by Prof. Locatelli’s team and carried out in the Pediatric Hospital of the Santa Sede, which holds the largest number of cases in the world: about 700 transplants from parents have been performed to date on children with leukemia and blood cancer.

The child is now well: there have been no post-operative complications, the father’s cells are multiplying and his son is on his way to complete recovery. With the manipulation methods available today, the percentage of healing with a marrow transplant from one of the parents can be compared to that obtained using a perfectly suitable donor.

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