Rechazo a trasplante de médula compatible, en paciente pediátrica con aplasia medular: reporte de caso

Abstract

Introduction: Aplastic anemia is a pathology with an incidence of 2-3 cases per million children under 15 years of age; its etiology and evolution are variable, and the diagnosis represents a medical challenge because its clinical picture is not prodromal. Treatment must be individualized, and new therapeutic alternatives continue to be studied since existing pharmacological therapies are not fully effective. Rejection of allogeneic transplantation is very infrequent in transplant recipients and is a severe complication with high mortality. Objective: To examine an unusual allogeneic bone marrow transplant rejection case in a pediatric patient with severe aplastic anemia. Case presentation: We report the case of an 11-year-old female patient with severe bone marrow aplasia diagnosed at age 7, who, after receiving immunosuppression therapy with a low response, underwent an allogeneic hematopoietic cell transplant with a related donor (sister-sister), with 100% compatibility; however, soon after, she presented graft rejection. Conclusions: Polytransfused patients with an irregular conditioning regimen and a history of having received immunosuppressive therapy present a lower response to Alo-TPH, with a high possibility to graft rejection. In this case, it is possible to identify these factors, which may or may not have influenced graft rejection.