Clinical and laboratory outcomes after umbilical cord blood transplantation in a patient with mucolipidosis II alpha/beta

Am J Med Genet A. 2016 May;170A(5):1278-82. doi: 10.1002/ajmg.a.37563. Epub 2016 Jan 20.

Abstract

Mucolipidosis (ML) II alpha/beta is an autosomal recessive disease caused by reduced enzyme activity of N-acetylglucosamine-1-phosphotransferase. Clinical symptoms of ML II are severe psychomotor delay and dysostosis multiplex; death usually occurs by 5-8 years of age from cardiopulmonary complications. Allogeneic hematopoietic stem cell transplantation (HSCT) has been attempted for ML; however, few reports have documented the detailed outcomes of HSCT for ML. A 26-month-old girl received a human leukocyte antigen 3/6-allele-matched transplant from cord blood. The preparative regimen consisted of fludarabine, cyclophosphamide, 6-Gy total body irradiation, and rabbit antithymocyte globulin. Although comparing before and after cord blood transplantation results, we observed that lysosomal enzyme activities in the plasma decreased by approximately 20-40%. Low serum levels of immunoglobulin A, G2, and G4 were also observed before HSCT; however, these values normalized after transplantation. Despite undergoing HSCT, she was treated twice for bacterial pneumonia with acute respiratory distress syndrome at ages 37 and 38 months. Although HSCT effects on the clinical manifestations were limited, laboratory data including plasma lysosomal enzyme activities and serum levels of immunoglobulin showed improvement.

Keywords: cord blood transplantation; mucolipidosis II; plasma lysosomal enzyme activity; psychomotor development.

Publication types

  • Case Reports

MeSH terms

  • Abnormalities, Multiple / blood
  • Abnormalities, Multiple / genetics*
  • Abnormalities, Multiple / physiopathology
  • Abnormalities, Multiple / therapy
  • Animals
  • Child, Preschool
  • Cord Blood Stem Cell Transplantation*
  • Cyclophosphamide / administration & dosage
  • Female
  • Humans
  • Immunoglobulins / blood
  • Mucolipidoses / blood
  • Mucolipidoses / genetics*
  • Mucolipidoses / physiopathology
  • Mucolipidoses / therapy
  • Psychomotor Disorders / blood
  • Psychomotor Disorders / genetics*
  • Psychomotor Disorders / physiopathology
  • Psychomotor Disorders / therapy
  • Rabbits
  • Transferases (Other Substituted Phosphate Groups) / genetics*
  • Transplantation, Homologous
  • Vidarabine / administration & dosage
  • Vidarabine / analogs & derivatives

Substances

  • Immunoglobulins
  • Cyclophosphamide
  • Transferases (Other Substituted Phosphate Groups)
  • UDP-N-acetylglucosamine-lysosomal-enzyme-N-acetylglucosaminephosphotransferase
  • Vidarabine
  • fludarabine

Supplementary concepts

  • Mucolipidosis II Alpha Beta