[PAGID] transplant question

[Christine Seroogy]

I am involved with a SCID patient (confirmed Rag 2 mutation) who is D 
+90 from matched cord blood transplant who has had a considerable  
change in her peripheral blood lymphocyte population.  She is  
currently on prednisone and CsA for GVH prophylaxis and was doing  
well until about 10 days ago when she developed a pruritic total body  
skin rash (similar to her OS rash prior to transplant.)  Her flow  
demonstrated significant loss of CD3+ cells over the past month (abs.  
CD3+CD4+ 140 and month before 440--meds have not changed) and  
expansion of NK cells (CD2+CD56+CD3-CD16-, absolute 556 and  
represents 81% of peripheral blood lymphocytes).  STR one month ago  
on CD3+ cells was 86% donor.  I am concerned about this change, but  
am uncertain if it is related to her clinical picture and how to  
further pursue it.  Our transplant team is primarily managing her.   
We intend to obtain a skin biopsy, but management probably won't  
change based on this.  I am wondering if others have seen this in the  
post-transplant setting or have additional recommendations?  Many  
thanks, Chris




Chris Seroogy, M.D.
Assistant Professor
Dept. of Pediatrics
Mail:  H4/474 CSC, Mailstop 4108
Shipping:  H4/431 CSC, Mailstop 4108
600 Highland Ave.
Madison, WI  53792
phone: 608- 263-2652
fax: 608-265-0164

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