Immunologic recovery in children after alternative donor allogeneic transplantation for hematologic malignancies: Comparison of recipients of partially T cell-depleted peripheral blood stem cells and umbilical cord blood

Benjamin R. Oshrine, Yimei Li, David T. Teachey, Jennifer Heimall, David M. Barrett, Nancy Bunin

Research output: Contribution to journalArticlepeer-review

Abstract

Impaired immunologic recovery (IR) after hematopoietic stem cell transplantation (HSCT) is associated with increased risk for infections and relapse. Stem cell source and graft manipulation influence the kinetics of IR. Partial T cell depletion of peripheral blood stem cell (PBSC) grafts is a novel alternative method of graft manipulation for children. We compared IR in children undergoing HSCT for hematologic malignancies receiving either T cell-depleted (TCD)-PBSCs (n=55) or umbilical cord blood (UCB) (n=21) over a 7-year period at a single institution. PBSC grafts underwent exvivo negative selection for CD3+ cells using the CliniMACS system with partial T cell add-back. Recovery of CD4+ T cells was significantly delayed in TCD-PBSC recipients compared with UCB recipients, owing to impaired CD4+/CD45RA+ (naïve) T cell lymphopoiesis. Recovery of total CD3+ cells and CD3+/CD8+ cells was similar in the 2 groups. The TCD-PBSC recipients had a marked deficit in CD19+ and, to a lesser extent, IgA/IgM, owing to the need for B cell depletion of these grafts to attenuate the risk of lymphoproliferative disease after TCD HSCT. There were no significant between-group differences in response to mitogen stimulation, time to independence from intravenous immunoglobulin supplementation, or incidence of viral reactivation. Transplantation outcomes of relapse, transplantation-related mortality, event-free survival, and overall survival were similar in the 2 groups. Efforts to enhance IR after partial TCD-PBSC transplantation, such as selective αβ T cell depletion, hold promise for further improvement of this transplantation approach.

Original languageEnglish (US)
Pages (from-to)1581-1589
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number11
DOIs
StatePublished - Nov 2013
Externally publishedYes

Keywords

  • Hematopoietic stem cell transplantation
  • Immune reconstitution
  • Pediatric
  • T cell depletion

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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