1. T cell depletion utilizing CD34+ stem cell selection and CD3+ addback from unrelated adult donors in paediatric allogeneic stem cell transplantation recipients.
- Author
-
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, and Cairo, Mitchell S.
- Subjects
- *
STEM cell transplantation , *PEDIATRICS , *T cells , *CD34 antigen , *GRAFT versus host disease , *VIRUS diseases , *ORGAN donors , *LYMPHOPROLIFERATIVE disorders - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF