Five donors -: one recipient:: modeling a mosaic of granulocytes, natural killer and T cells from cord-blood and third-party donors

Background A 21-year-old man was admitted to hospital because of leukocytosis, thrombocytopenia and anemia. The patient had been in good health until a few days earlier, when he developed fever and night sweats and his performance status dramatically declined. Investigations Laboratory tests, immunophenotyping, cytogenetic analyses, bone-marrow biopsy, minimal residual disease analysis using quantitative real-time polymerase chain reaction, differential chimerism analysis using flow cytometry, mixed chimerism analysis, CT scans, electro-encephalography, cerebral magnetic resonance tomography. Diagnosis Bcr-abl-positive and Philadelphia-chromosome-positive acute lymphoblastic leukemia, and primary graft failure complicated by invasive fungal infection and cytomegalovirus encephalitis. Management Double cord-blood rescue transplantation, third-party CD34-positive stem-cell rescue transplantation, third-party cytomegalovirus-specific T lymphocyte transplantation.