Favorable immune recovery and low rate of GvHD in children transplanted with partially T cell-depleted PBSC grafts
Transplantation of peripheral blood stem cells (PBSC) from matched unrelated donors (MUD) is still associated with a significant risk for graft vs. host disease (GvHD), especially in pediatric patients receiving grafts from adult donors containing high amounts of T cells. Here, we present long-term...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2019
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| In: |
Bone marrow transplantation
Year: 2018, Volume: 54, Issue: 1, Pages: 53-62 |
| ISSN: | 1476-5365 |
| DOI: | 10.1038/s41409-018-0212-7 |
| Online Access: | Verlag, Volltext: https://doi.org/10.1038/s41409-018-0212-7 Verlag, Volltext: https://www.nature.com/articles/s41409-018-0212-7 
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| Author Notes: | Christian Martin Seitz, Matthias Eyrich, Johann Greil, Patrick Schlegel, Tobias Feuchtinger, Peter Bader, Martin Ebinger, Carl Philipp Schwarze, Paul Gerhardt Schlegel, Michael Schumm, Rupert Handgretinger, Peter Lang |
| Summary: | Transplantation of peripheral blood stem cells (PBSC) from matched unrelated donors (MUD) is still associated with a significant risk for graft vs. host disease (GvHD), especially in pediatric patients receiving grafts from adult donors containing high amounts of T cells. Here, we present long-term follow-up results on 25 pediatric patients, (acute leukemia n = 15, NHL n = 3, CML n = 3, MDS n = 5), transplanted with CD34 or CD133 positively selected PBSC from MUDs supplemented with an add-back of 1 × 107/kg body weight (kgBW) unselected T cells resulting in a median T-cell depletion (TCD) of 1.97 log. A total of 24/25 (96%) patients had primary engraftment. Early T-cell recovery was significantly improved compared to patients receiving CD34-selected grafts without T-cell add-back and similar to patients receiving unmanipulated bone marrow. GvHD incidence was low with 8/4% aGvHD grade II/III, no grade IV and 13% limited cGvHD. In total, 16/25 (64%) patients are alive after a median follow-up of 10 years. Five-year event-free survival (EFS) was 68%, relapse probability 24% and transplantation-related mortality (TRM) 12%. Thus, in PBSC allotransplants from MUD, partial TCD with serotherapy and CSA/MTX prophylaxis, can effectively reduce GvHD without hampering engraftment and immune reconstitution. |
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| Item Description: | Published online: 24 May 2018 Gesehen am 02.08.2019 |
| Physical Description: | Online Resource |
| ISSN: | 1476-5365 |
| DOI: | 10.1038/s41409-018-0212-7 |