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Impact of Genetic Diagnosis on the Outcome of Hematopoietic Stem Cell Transplant in Primary Immunodeficiency Disorders.

Authors :
Forlanini F
Chan A
Dara J
Dvorak CC
Cowan MJ
Puck JM
Dorsey MJ
Source :
Journal of clinical immunology [J Clin Immunol] 2023 Apr; Vol. 43 (3), pp. 636-646. Date of Electronic Publication: 2022 Dec 10.
Publication Year :
2023

Abstract

To evaluate the relationship between knowledge of genetic diagnosis before HSCT and outcome, we reviewed all HSCTs for primary immune deficiencies (PID) performed at UCSF from 2007 through 2018. SCID, a distinct entity identified since 2010 in California by newborn screening and treated early, was considered separately. The underlying genetic condition was known at the time of HSCT in 85% of cases. Graft failure was less frequent in patients with a genetic diagnosis (19% with a genetic diagnosis versus 47% without, p = 0.020). Furthermore, event-free survival and overall survival (OS) at 5 years were better for those with a genetic diagnosis (78% with versus 44% without, p = 0.006; and 93% versus 60% without, p = 0.0002, respectively). OS at 5 years was superior for known-genotype patients with both SCID (p = 0.010) and non-SCID PID (p = 0.010). There was no difference in OS between HSCT done in 2007-2010 compared to more recently (p = 0.19). These data suggest that outcomes of HSCT for PID with known genotype may reflect specific experience and literature, or that a substantial proportion of patients with PID of undetermined genotype may have had underlying conditions for which HSCT may carry greater risk. The higher rate of graft failure in PID with unknown genotype may be in part explained by insufficient conditioning, which in turn could be dictated by compromised organ function in patients undergoing HSCT late in the course. Widespread availability of PID gene sequencing as standard care can provide genetic diagnoses for most patients with PID prior to HSCT, permitting optimization of transplant approach.<br /> (© 2022. The Author(s).)

Details

Language :
English
ISSN :
1573-2592
Volume :
43
Issue :
3
Database :
MEDLINE
Journal :
Journal of clinical immunology
Publication Type :
Academic Journal
Accession number :
36495401
Full Text :
https://doi.org/10.1007/s10875-022-01403-5