Successful human umbilical cord blood stem cell transplantation without conditioning in severe combined immune deficiency.

A 2-month-old girl with severe combined immunodeficiency (SCID), presented with mild staphylococcal skin infection, lymphopenia, low T cell number, absence of B cells, high number of NK cells, and a negligible response to mitogens. Since her older brother died as a result of SCID 2 years earlier, cord blood was harvested from a sister born 2 1/2 years earlier, who was normal and fully matched both by serology and molecular typing. In view of her clinical condition and in spite of a high number of NK cells with normal activity, HUCBT without preparative conditioning was performed. No G-CSF was administered. Engraftment with mixed chimerism was evident 3 weeks post transplantation. There were no peritransplantation complications. Eighteen months post transplantation, the girl is in excellent condition, blood counts are normal, T cell engraftment is complete, B cell engraftment is proceeding gradually, and the mitogen stimulation tests are normal. Due to the unique nature of HUCB hematopoietic cells, engraftment without conditioning may be possible in patients with SCID with fully matched donors. This is the first HUCBT performed without conditioning.

[Rubella encephalitis].

Morbidity in rubella is generally mild, and neurological complications are rare, varying from 1:6000-1:24,000. We describe an 11-year-old girl with severe manifestations of rubella encephalitis. The onset of encephalitis most often occurs within 1-6 days after development of the typical rash. Neurological features vary and include encephalitis, carotid artery thrombosis, myelitis, optic neuritis, Guillain-Barre syndrome, and peripheral neuritis. Rubella should be considered in the differential diagnosis of encephalitis despite the current vaccination program in Israel. Such cases should be prevented by encouraging widespread early childhood vaccination.