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T cell depletion utilizing CD 34 + stem cell selection and CD 3 + addback from unrelated adult donors in paediatric allogeneic stem cell transplantation recipients
Author(s) -
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,
SemideiPomales Mildred,
Schwartz Joseph,
Alobeid Bachir,
BaxterLowe Lee Ann,
Cairo Mitchell S.
Publication year - 2012
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2012.09048.x
Subject(s) - medicine , transplantation , stem cell , immunology , graft versus host disease , hematopoietic stem cell transplantation , cd34 , gastroenterology , biology , genetics
Summary CD 34‐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 CD 34‐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 × 10 5 CD 3 + /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. CD 34‐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 .