High-Dose ERT, Rituximab, and Early HSCT in an Infant with Wolman's Disease.

Eskandari, Siawosh K; Revenich, Elisabeth G M; Pot, Dirk J; de Boer, Foekje; Bierings, Marc; van Spronsen, Francjan J; van Hasselt, Peter M; Lindemans, Caroline A et al. · N Engl J Med · 2024

case_report · Level V

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Abstract

Wolman's disease, a severe form of lysosomal acid lipase deficiency, leads to pathologic lipid accumulation in the liver and gut that, without treatment, is fatal in infancy. Although continued enzyme-replacement therapy (ERT) in combination with dietary fat restriction prolongs life, its therapeutic effect may wane over time. Allogeneic hematopoietic stem-cell transplantation (HSCT) offers a more definitive solution but carries a high risk of death. Here we describe an infant with Wolman's disease who received high-dose ERT, together with dietary fat restriction and rituximab-based B-cell depletion, as a bridge to early HSCT. At 32 months, the infant was independent of ERT and disease-free, with 100% donor chimerism in the peripheral blood.

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