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Curative treatment of autosomal-recessive hyper-IgE syndrome by hematopoietic cell transplantation.

Abstract
Autosomal-recessive hyper-IgE syndrome (AR-HIES) is a combined immunodeficiency recently found to be associated with mutations of DOCK8. Clinically, this disorder is characterized beside recurrent bacterial complications, in particular by an unusual susceptibility to extensive cutaneous viral complications and by a high risk for squamous cell carcinoma. Here, we report on lasting control over the disorder in two patients by hematopoietic cell transplantation (HCT). Both patients were suffering from extensive long-lasting cutaneous viral complications, in particular from disfiguring molluscum contagiosum infections, when treated at the age of 10 and 17 years. Donors were matched unrelated, and conditioning was carried out with a combination of fludarabine, melphalan and BM-targeted radioimmunotherapy. Both patients developed stable, full donor cell chimerism, with the exception of persistent low-IgA serum levels and the exception of normal immune functions. Over the course of several months, cutaneous manifestations of viral disease resolved completely and both patients remain clinically well and free of infectious complications at 4 and 2 years, respectively, after transplantation. This represents the first report indicating HCT to be curative in patients with AR-HIES, which should be considered early before life-threatening complications develop, which include malignancies.
AuthorsS A Gatz, U Benninghoff, C Schütz, A Schulz, M Hönig, U Pannicke, K-H Holzmann, K Schwarz, W Friedrich
JournalBone marrow transplantation (Bone Marrow Transplant) Vol. 46 Issue 4 Pg. 552-6 (Apr 2011) ISSN: 1476-5365 [Electronic] England
PMID20622910 (Publication Type: Case Reports, Journal Article)
Chemical References
  • DOCK8 protein, human
  • Guanine Nucleotide Exchange Factors
Topics
  • Adolescent
  • Child
  • Guanine Nucleotide Exchange Factors (genetics)
  • Hematopoietic Stem Cell Transplantation (methods)
  • Humans
  • Job Syndrome (complications, therapy)
  • Molluscum Contagiosum (etiology, therapy)
  • Remission Induction
  • Treatment Outcome

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