Document Type : Case Report

Authors

• Heba M. Bahlol ^{1, 2}
• Sohaila M. Khalil ^{1, 2}
• Mohamed R. El-Shanshory ^{2, 3}
• Mohamed L. Salem ^{1, 2}

¹ Immunology and Parasitology Division, Zoology Department, Faculty of Science, Tanta University, Tanta, Egypt.

² Center of Excellence in Cancer Research, New Tanta University Teaching Hospital, Tanta University, Egypt.

³ Pediatric Oncology, Faculty of Medicine, Tanta University, Tanta, Egypt.

Abstract

Hematopoietic stem cell transplantation (HSCT) is the only curative therapy for β-thalassemia major in children. However, it often induces graft-versus-host-disease (GVHD), which is associated with complications. In the present study, we used cyclophosphamide (Cy) to treat a thalassemia patient post-HSCT to reduce the adverse effects of GVHD. We monitored the numbers and phenotype of granulocytes. In this case study, an 11-year-old female patient, diagnosed with β-thalassemia major (Pesaro class II), was treated with Cy before and after HSCT with mobilized CD34⁺ cells. Both the relative and absolute granulocyte counts, as well as CD33⁺CD11b⁺ cell counts, increased significantly after HSCT until day 56. However, they suddenly began to decrease after day 56, accompanied by severe diarrhea, skin rash, and a decrease in bilirubin levels compared to day -12. Furthermore, compared to day -12, IL-22 levels increased until day 56, and then decreased, while IDO levels continued to rise after day 56. Our data suggest the potential use of IL-22 and IDO as biomarkers for GVHD assessment. It also indicates that Cy promotes HSCT reconstitution by increasing CD33⁺CD11b⁺ cells, which may play a crucial role in reducing GVHD risks. However, further studies are needed to elucidate the mechanism behind GVHD recurrence.

Keywords

• B-thalassemia
• Granulocytes
• Cyclophosphamide
• GVHD
• HSCT