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- Title
T cell depletion utilizing CD34<sup>+</sup> stem cell selection and CD3<sup>+</sup> addback from unrelated adult donors in paediatric allogeneic stem cell transplantation recipients.
- Authors
Geyer, Mark B.; Ricci, Angela M.; Jacobson, Judith S.; Majzner, Robbie; Duffy, Deirdre; Ven, Carmella; Ayello, Janet; Bhatia, Monica; Garvin, James H.; George, Diane; Satwani, Prakash; Harrison, Lauren; Morris, Erin; Semidei-Pomales, Mildred; Schwartz, Joseph; Alobeid, Bachir; Baxter-Lowe, Lee Ann; Cairo, Mitchell S.
- Abstract
Summary CD34-selected haploidentical and unrelated donor allogeneic stem cell transplantation (Allo SCT) in paediatric recipients is associated with sustained engraftment and low risk of acute graft- versus-host disease (a GVHD), but limited by delayed immune reconstitution and increased risk of viral and fungal infection. The optimal dose of donor T cells to prevent graft failure and minimize risk of early opportunistic infection and post-transplant lymphoproliferative disorder ( PTLD), while avoiding severe a GVHD, remains unknown. We prospectively studied CD34-selected 8-10/10 human leucocyte antigen ( HLA)-matched unrelated donor ( MUD) peripheral blood stem cell transplantation ( PBSCT) in a cohort of 19 paediatric Allo SCT recipients with malignant ( n = 13) or non-malignant ( n = 6) diseases. T cells were added back to achieve total dose 1·0-2·5 × 105 CD3+/kg. GVHD pharmacoprophylaxis consisted only of tacrolimus. All patients engrafted neutrophils. Probabilities of grade II- IV a GVHD, limited chronic GVHD (c GVHD), and extensive c GVHD were 15·8%, 23·3%, and 0%, respectively. One patient developed PTLD. One-year infection-related mortality was 5·6%. T cell immune reconstitution was delayed. One-year overall survival was 82·3%. Five patients with malignant disease ultimately died from progressive disease. CD34-selected MUD PBSCT using a defined dose of T cell add-back resulted in high rates of engraftment and low risk of grade II- IV a GVHD, early transplantation-related mortality, and extensive c GVHD.
- Subjects
STEM cell transplantation; PEDIATRICS; T cells; CD34 antigen; GRAFT versus host disease; VIRUS diseases; ORGAN donors; LYMPHOPROLIFERATIVE disorders
- Publication
British Journal of Haematology, 2012, Vol 157, Issue 2, p205
- ISSN
0007-1048
- Publication type
Article
- DOI
10.1111/j.1365-2141.2012.09048.x