Low-dose donor memory T-cell infusion after TCR alpha/beta depleted unrelated and haploidentical transplantation: results of a pilot trial

Bone Marrow Transplant. 2018 Mar;53(3):264-273. doi: 10.1038/s41409-017-0035-y. Epub 2017 Dec 21.

Abstract

Recovery of immunity is delayed in recipients of T-depleted grafts. Adoptive transfer of memory T-cells may improve immune response to common pathogens. A cohort of 53 patients with malignant (n = 36) and non-malignant conditions (n = 17) received TCR alpha/beta depleted grafts from haploidentical (n = 25) or MUD (n = 28) donors. Donor lymphocytes were depleted of CD45RA-positive cells. At a median of 48 days after transplantation, patients received DLI at 25 × 103/kg CD3 cells from haploidentical or 100 × 103/kg CD3 from MUD donors. Up to 3 doses of donor lymphocytes were administered at monthly intervals, escalating to 100 × 103/kg in haploidentical transplants and 300 × 103/kg in MUD transplants. At a median follow-up of 23 months, the cumulative incidence of de novo acute GVHD after DLI is 2% (1 of 43), while the rate of reactivation of preexisting aGVHD was 50% (5 of 10). The transplant-related mortality is 6%. The overall survival rates are 80% and 88% in malignant and non-malignant conditions, respectively. Among patients with absent CMV-specific immune reactivity at baseline (n = 31) expansion of CMV-specific T-cells was demonstrated in 20 (64.5%) within 100 days. Infusions of low dose donor memory T-lymphocytes are safe and constitute a simple measure to prevent infections in the setting of alpha/beta T cell-depleted transplantation.

MeSH terms

  • Adoptive Transfer
  • Cytomegalovirus Infections / prevention & control
  • Graft vs Host Disease
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Immunologic Memory*
  • Lymphocyte Depletion / methods*
  • Lymphocyte Transfusion / methods*
  • Pilot Projects
  • Receptors, Antigen, T-Cell, alpha-beta
  • Survival Analysis
  • T-Lymphocytes
  • Transplantation, Haploidentical / methods*

Substances

  • Receptors, Antigen, T-Cell, alpha-beta