TY - JOUR
T1 - Early viral reactivation despite excellent immune reconstitution following haploidentical Bone marrow transplant with post-transplant cytoxan for sickle cell disease
AU - Patel, Dilan A.
AU - Dhedin, Nathalie
AU - Chen, Heidi
AU - Karnik, Leena
AU - Gatwood, Katie
AU - Culos, Katie
AU - Mohan, Sanjay
AU - Engelhardt, Brian G.
AU - Kitko, Carrie
AU - Connelly, Jim
AU - Satyanarayana, Gowri
AU - Jagasia, Madan
AU - De La Fuente, Josu
AU - Kassim, Adetola
N1 - Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background: Haploidentical bone marrow transplant (haplo-BMT) offers near universal donor availability as a curative modality for individuals with severe sickle cell disease (SCD). However, the required intense immunodepletion is associated with increased infectious complications. A paucity of data exists on immune reconstitution following haplo-BMT for SCD. Methods: A multi-institution learning collaborative was developed in the context of a phase II clinical trial of a non-myeloablative, related haplo-BMT with post-transplant cyclophosphamide for SCD. We report results from a cohort of 23 patients for whom immune reconstitution data up to one year were available. Results: Median age was 14.8 years. Out of 23, 18 participants received pre-conditioning with azathioprine, hydroxyurea, and hypertransfusions. 70% (16/23) of participants had multiple indications for haplo-BMT. We observed excellent immune reconstitution of CD4, CD8, CD19, and CD56 cellular subsets by 6 months post transplant. Engraftment rate and event-free survival in this cohort were 100% and 96%, respectively. 70% (16/23) of patients had at least one viral reactivation or infection, including CMV 35% (8/23), HHV-6 22% (5/23), and polyoma virus 17% (4/23), with no cases of post-transplant lymphoproliferative disease. Conclusion: Further prospective studies are needed to better characterize immune reconstitution and the immunologic basis for increased viral reactivation following haplo-BMT with post-transplant cyclophosphamide for SCD.
AB - Background: Haploidentical bone marrow transplant (haplo-BMT) offers near universal donor availability as a curative modality for individuals with severe sickle cell disease (SCD). However, the required intense immunodepletion is associated with increased infectious complications. A paucity of data exists on immune reconstitution following haplo-BMT for SCD. Methods: A multi-institution learning collaborative was developed in the context of a phase II clinical trial of a non-myeloablative, related haplo-BMT with post-transplant cyclophosphamide for SCD. We report results from a cohort of 23 patients for whom immune reconstitution data up to one year were available. Results: Median age was 14.8 years. Out of 23, 18 participants received pre-conditioning with azathioprine, hydroxyurea, and hypertransfusions. 70% (16/23) of participants had multiple indications for haplo-BMT. We observed excellent immune reconstitution of CD4, CD8, CD19, and CD56 cellular subsets by 6 months post transplant. Engraftment rate and event-free survival in this cohort were 100% and 96%, respectively. 70% (16/23) of patients had at least one viral reactivation or infection, including CMV 35% (8/23), HHV-6 22% (5/23), and polyoma virus 17% (4/23), with no cases of post-transplant lymphoproliferative disease. Conclusion: Further prospective studies are needed to better characterize immune reconstitution and the immunologic basis for increased viral reactivation following haplo-BMT with post-transplant cyclophosphamide for SCD.
KW - haploidentical bone marrow transplant
KW - immune reconstitution
KW - sickle cell disease
KW - viral reactivation
UR - http://www.scopus.com/inward/record.url?scp=85076735775&partnerID=8YFLogxK
U2 - 10.1111/tid.13222
DO - 10.1111/tid.13222
M3 - Article
C2 - 31782875
AN - SCOPUS:85076735775
SN - 1398-2273
VL - 22
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
IS - 1
M1 - e13222
ER -