Haploidentic transplantation injury failure in a girl with acute myeloid leukemia

We describethe case of a 6 year old patient with high risk acute myeloid leukemia (AML), who received consolidation with a haploidentical paternal donor transplant with post-transplant cyclophosphamide to prevent graft versus host disease. Presents myeloid graft at day +14, chimerism of 90%, presenting graft failure at day +16. Secondary graft failure mediated by donor specific antibodies is diagnosed, desensitization is performed by immunoglobulin, rituximab and plasmapheresis therapy, and a 2nd. Transplant is performed, of the same donor, without success, raising the percentage of donor specific antibodies to 81% after the 2nd. Transplant. A new desensitization scheme is administered and ant thymocyte gamma globulin is added. Then, a 3rd. Haploidentical maternal donor transplant with post-transplant cyclophosphamide is performed. The patient has a successful myeloid graft on day +13 and pre-engrafment syndrome, as well as infection by BK virus consistent with prolonged deep neutropenia. Currently the patient is without infection, stable and conserving myeloid graft