GvL effects in T-prolymphocytic leukemia: evidence from MRD kinetics and TCR repertoire analyses

Bone Marrow Transplant. 2017 Apr;52(4):544-551. doi: 10.1038/bmt.2016.305. Epub 2016 Dec 12.

Abstract

Allogeneic stem cell transplantation (alloSCT) is used for treating patients with T-prolymphocytic leukemia (T-PLL). However, direct evidence of GvL activity in T-PLL is lacking. We correlated minimal residual disease (MRD) kinetics with immune interventions and T-cell receptor (TCR) repertoire diversity alterations in patients after alloSCT for T-PLL. Longitudinal quantitative MRD monitoring was performed by clone-specific real-time PCR of TCR rearrangements (n=7), and TCR repertoire diversity assessment by next-generation sequencing (NGS; n=3) Although post-transplant immunomodulation (immunosuppression tapering or donor lymphocyte infusions) resulted in significant reduction (>1 log) of MRD levels in 7 of 10 occasions, durable MRD clearance was observed in only two patients. In all three patients analyzed by TCR-NGS, MRD responses were reproducibly associated with a shift from a clonal, T-PLL-driven profile to a polyclonal signature. Novel clonotypes that could explain a clonal GvL effect did not emerge. In conclusion, TCR-based MRD quantification appears to be a suitable tool for monitoring and guiding treatment interventions in T-PLL. The MRD responses to immune modulation observed here provide first molecular evidence for GvL activity in T-PLL which, however, may be often only transient and reliant on a poly-/oligoclonal rather than a monoclonal T-cell response.

MeSH terms

  • Adult
  • Aged
  • Clone Cells / immunology
  • Gene Rearrangement, T-Lymphocyte / genetics
  • Graft vs Leukemia Effect*
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Immunomodulation*
  • Kinetics
  • Leukemia, Prolymphocytic, T-Cell / diagnosis
  • Leukemia, Prolymphocytic, T-Cell / therapy*
  • Middle Aged
  • Neoplasm, Residual / diagnosis*
  • Neoplasm, Residual / genetics
  • Real-Time Polymerase Chain Reaction
  • Receptors, Antigen, T-Cell / analysis*
  • Receptors, Antigen, T-Cell / genetics
  • Stem Cell Transplantation / methods*
  • Transplantation, Homologous

Substances

  • Receptors, Antigen, T-Cell