---
title: "Second Cord Blood Transplantation Achieves Engraftment After Primary Graft Failure in Relapsed Ped"
id: "pubmed-42669944"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42669944"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42669944/"
published_at: "2026-09-20T00:00:00.000Z"
evidence_level: "Case Reports"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Second Cord Blood Transplantation Achieves Engraftment After Primary Graft Failure in Relapsed Ped
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42669944
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42669944/)
- **Published At:** 2026-09-20T00:00:00.000Z
- **Evidence Rating:** Case Reports
## Executive GIST (TL;DR)
- Primary graft failure following **umbilical cord blood transplantation (UCBT)** is uncommon but can be life-threatening in pediatric patients with relapsed B-cell precursor acute lymphoblastic leukemia (B-ALL). - The report describes a 9-year-old boy with relapsed B-ALL who experienced primary graft failure after a first UCBT performed in second complete remission. - The initial cord blood unit had a low **CD34-positive cell** dose and notable **HLA** and ABO incompatibility; myeloablative conditioning was used but neutrophil engraftment did not occur and donor chimerism remained minimal. - An urgent second UCBT was done using a different cord blood unit selected for better HLA compatibility and substantially higher total nucleated cell and **CD34-positive** cell counts. - The second transplant used a reduced-intensity conditioning regimen consisting of **fludarabine** and low-dose total body irradiation prior to infusion. - Sustained neutrophil engraftment occurred on day +34 after the second UCBT, with subsequent stable full donor chimerism. - Post-transplant complications included hemophagocytic syndrome, sinusoidal obstruction syndrome, acute graft-versus-host disease, and viral reactivation; each was successfully managed according to the report. - The case supports that, when no suitable alternative donor is available and rapid action is taken, a timely second UCBT can be a feasible salvage option after primary graft failure in children.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliation * 1 Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan. shohei-y@tokai.ac.jp. * PMID: **42669944** Free article Item in Clipboard Case Reports # Successful Engraftment Following Second Cord Blood Transplantation After Graft Failure in a Child With Relapsed B-ALL Ryota Kaneko et al. Tokai J Exp Clin Med. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Tokai J Exp Clin Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Tokai+J+Exp+Clin+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Tokai+J+Exp+Clin+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42669944/) . 2026 Sep 20;51(3):134-137. ### Authors [Ryota Kaneko](https://pubmed.ncbi.nlm.nih.gov/?term=Kaneko+R&cauthor_id=42669944), [Takashi Koike](https://pubmed.ncbi.nlm.nih.gov/?term=Koike+T&cauthor_id=42669944), [Yukie Yokoyama](https://pubmed.ncbi.nlm.nih.gov/?term=Yokoyama+Y&cauthor_id=42669944), [Mayuko Shibata](https://pubmed.ncbi.nlm.nih.gov/?term=Shibata+M&cauthor_id=42669944), [Sachio Fujita](https://pubmed.ncbi.nlm.nih.gov/?term=Fujita+S&cauthor_id=42669944), [Kosuke Akiyama](https://pubmed.ncbi.nlm.nih.gov/?term=Akiyama+K&cauthor_id=42669944), [Daisuke Toyama](https://pubmed.ncbi.nlm.nih.gov/?term=Toyama+D&cauthor_id=42669944), [Shohei Yamamoto](https://pubmed.ncbi.nlm.nih.gov/?term=Yamamoto+S&cauthor_id=42669944)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669944/#short-view-affiliation-1 "Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan. shohei-y@tokai.ac.jp.") ### Affiliation * 1 Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan. shohei-y@tokai.ac.jp. * PMID: **42669944** Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract Primary graft failure is a rare but life-threatening complication after umbilical cord blood transplantation (UCBT), especially in pediatric patients with relapsed acute lymphoblastic leukemia (ALL). Optimal salvage strategies, including conditioning regimens and donor selection for second transplantation, have not been established. This report describes the case of a 9-year-old boy with relapsed B-cell precursor ALL who developed primary graft failure following the first UCBT performed during his second complete remission. The initial transplant had used a cord blood unit with a low CD34-positive cell dose and significant human leukocyte antigen (HLA) and ABO mismatch. Despite myeloablative conditioning, neutrophil engraftment failed, and donor chimerism remained minimal. An urgent second UCBT was performed using a different cord blood unit with improved HLA compatibility and markedly higher total nucleated and CD34-positive cell doses, following reduced-intensity conditioning with fludarabine and low-dose total body irradiation. Sustained neutrophil engraftment was achieved on day +34, with stable full donor chimerism thereafter. Post-transplant complications, including hemophagocytic syndrome, sinusoidal obstruction syndrome, acute graft-versus-host disease, and viral reactivation, were successfully managed. This pediatric case demonstrates that, in the absence of a suitable donor and with prompt intervention, a second UCBT is a feasible salvage option after primary graft failure. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Alemtuzumab, Fludarabine, Low-Dose TBI, and Double Umbilical Cord Transplant for Primary Graft Failure in a Patient with Recurrent HLH. ](https://pubmed.ncbi.nlm.nih.gov/26488531/) Hege K, Quigg T, Delgado D.Hege K, et al.Pediatr Blood Cancer. 2016 Feb;63(2):361-3. doi: 10.1002/pbc.25782. Epub 2015 Oct 21.Pediatr Blood Cancer. 2016.PMID: 26488531 * [ Reduced-intensity conditioning in unrelated donor cord blood transplantation for familial hemophagocytic lymphohistiocytosis. ](https://pubmed.ncbi.nlm.nih.gov/22488407/) Nishi M, Nishimura R, Suzuki N, Sawada A, Okamura T, Fujita N, Kanai R, Yano J, Adachi S, Yasumi T, Sato E, Yasutomo K, Ishii E, Ohga S.Nishi M, et al.Am J Hematol. 2012 Jun;87(6):637-9. doi: 10.1002/ajh.23190. Epub 2012 Apr 10.Am J Hematol. 2012.PMID: 22488407 * [ Hematopoietic stem cell transplantation using single UM171-expanded cord blood: a single-arm, phase 1-2 safety and feasibility study. ](https://pubmed.ncbi.nlm.nih.gov/31704264/) Cohen S, Roy J, Lachance S, Delisle JS, Marinier A, Busque L, Roy DC, Barabé F, Ahmad I, Bambace N, Bernard L, Kiss T, Bouchard P, Caudrelier P, Landais S, Larochelle F, Chagraoui J, Lehnertz B, Corneau S, Tomellini E, van Kampen JJA, Cornelissen JJ, Dumont-Lagacé M, Tanguay M, Li Q, Lemieux S, Zandstra PW, Sauvageau G.Cohen S, et al.Lancet Haematol. 2020 Feb;7(2):e134-e145. doi: 10.1016/S2352-3026(19)30202-9. Epub 2019 Nov 6.Lancet Haematol. 2020.PMID: 31704264Clinical Trial. * [ [Treatment of Gaucher disease with allogeneic hematopoietic stem cell transplantation: report of three cases and review of literatures]. ](https://pubmed.ncbi.nlm.nih.gov/26758318/) Tang X, Luan Z, Wu N, Zhang B, Jing Y, Du H, Lu W, Xu S.Tang X, et al.Zhonghua Er Ke Za Zhi. 2015 Nov;53(11):810-6.Zhonghua Er Ke Za Zhi. 2015.PMID: 26758318Review.Chinese. * [ Alloreactivity as therapeutic principle in the treatment of hematologic malignancies. Studies of clinical and immunologic aspects of allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning. ](https://pubmed.ncbi.nlm.nih.gov/17521527/) Petersen SL.Petersen SL.Dan Med Bull. 2007 May;54(2):112-39.Dan Med Bull. 2007.PMID: 17521527Review. 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