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- Title
Allogeneic Hematopoietic cell Transplantation Using Alemtuzumab in Asian Patients with Inborn Errors of Immunity.
- Authors
Miyamoto, Satoshi; Niizato, Daiki; Tomomasa, Dan; Nishimura, Akira; Hoshino, Akihiro; Kamiya, Takahiro; Isoda, Takeshi; Takagi, Masatoshi; Kajiwara, Michiko; Azumi, Shohei; Hirabayashi, Shinsuke; Sakamoto, Kenichi; Kishimoto, Kenji; Miyamura, Takako; Umeda, Katsutsugu; Hirose, Ayana; Keino, Dai; Yanagimachi, Masakatsu; Kanda, Kaori; Sakai, Yuta
- Abstract
Alemtuzumab is used with reduced-toxicity conditioning (RTC) in allogeneic hematopoietic cell transplantation (HCT), demonstrating efficacy and feasibility for patients with inborn errors of immunity (IEI) in Western countries; however, the clinical experience in Asian patients with IEI is limited. We retrospectively analyzed patients with IEI who underwent the first allogeneic HCT with alemtuzumab combined with RTC regimens in Japan. A total of 19 patients were included and followed up for a median of 18 months. The donors were haploidentical parents (n = 10), matched siblings (n = 2), and unrelated bone marrow donors (n = 7). Most patients received RTC regimens containing fludarabine and busulfan and were treated with 0.8 mg/kg alemtuzumab with intermediate timing. Eighteen patients survived and achieved stable engraftment, and no grade 3–4 acute graft-versus-host disease was observed. Viral infections were observed in 11 patients (58%) and 6 of them presented symptomatic. The median CD4+ T cell count was low at 6 months (241/µL) but improved at 1 year (577/µL) after HCT. Whole blood cells continued to exhibit > 80% donor type in most cases; however, 3/10 patients exhibited poor donor chimerism only among T cells and also showed undetectable levels of T-cell receptor recombination excision circles (TRECs) at 1 year post-HCT. This study demonstrated the efficacy and safety of alemtuzumab; however, patients frequently developed viral infections and slow reconstitution or low donor chimerism in T cells, emphasizing the importance of monitoring viral status and T-cell-specific chimerism. (238 < 250 words)
- Subjects
JAPAN; HEMATOPOIETIC stem cell transplantation; ASIANS; ALEMTUZUMAB; GRAFT versus host disease; T cells
- Publication
Journal of Clinical Immunology, 2024, Vol 44, Issue 6, p1
- ISSN
0271-9142
- Publication type
Article
- DOI
10.1007/s10875-024-01734-5