Peripheral Red Blood Cell Split Chimerism as a Consequence of Intramedullary Selective Apoptosis of Recipient Red Blood Cells in a Case of Sickle Cell Disease

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Marco Marziali
Antonella Isgrò
Pietro Sodani
Javid Gaziev
Daniela Fraboni
Katia Paciaroni
Cristiano Gallucci
Cecilia Alfieri
Andrea Roveda
Gioia De Angelis
Luisa Cardarelli
Michela Ribersani
Marco Andreani
Guido Lucarelli


Sickle Cell Disease, Split Chimeirsm, Bone Marrow


Allogeneic cellular gene therapy through hematopoietic stem cell transplantation is the only radical cure for congenital hemoglobinopathies like thalassemia and sickle cell anemia. Persistent mixed hematopoietic chimerism (PMC) has been described in thalassemia and sickle cell anemia. Here, we describe the clinical course of a 6-year-old girl who had received bone marrow transplant for sickle cell anemia. After the transplant, the patient showed 36% donor hematopoietic stem cells in the bone marrow, whereas in the peripheral blood there was evidence of 80%  circulating donor red blood cells (RBC). The analysis of apoptosis at the Bone Marrow  level suggests that Fas might contribute to the cell death of host erythroid precursors. The increase in NK cells and the regulatory T cell population observed in this patient suggests that these cells might contribute to the condition of mixed chimerism.


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