在先天性免疫缺陷中,T 细胞富含 HLA 匹配移植物与 T 细胞耗竭 HLA 不匹配移植物的比较。

T-replete HLA-matched grafts vs T-depleted HLA-mismatched grafts in inborn errors of immunity.

机构信息

Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.

Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.

出版信息

Blood Adv. 2022 Feb 22;6(4):1319-1328. doi: 10.1182/bloodadvances.2020004072.

Abstract

Hematopoietic cell transplantation (HCT) has become standard-of-care for an increasing number of inborn errors of immunity (IEI). This report is the first to compare transplant outcomes according to T-cell-replete (ie, T-replete) HLA-matched grafts using alemtuzumab (n = 117) and T-cell-depleted (ie, T-depleted) HLA-mismatched grafts using T-cell receptor-αβ (TCRαβ)/CD19 depletion (n = 47) in children with IEI who underwent first HCT between 2014 and 2019. All patients received treosulfan-based conditioning except patients with DNA repair disorders. For T-replete grafts, the stem cell source was marrow in 25 (21%) patients, peripheral blood stem cell (PBSC) in 85 (73%), and cord blood in 7 (6%). TCRαβ/CD19 depletion was performed on PBSCs from 45 haploidentical parental donors and 2 mismatched unrelated donors. The 3-year overall survival (OS) and event-free survival for the entire cohort were 85% (77%-90%) and 79% (69%-86%), respectively. Analysis according to age at transplant revealed a comparable 3-year OS between T-replete grafts (88%; 76%-94%) and T-depleted grafts (87%; 64%-96%) in younger patients (aged <5 years at HCT). For older patients (aged >5 years), the OS was significantly lower in T-depleted grafts (55%; 23%-78%) compared with T-replete grafts (87%; 68%-95%) (P = .03). Grade III to IV acute graft-versus-host disease was observed in 8% of T-replete marrow, 7% of T-replete PBSC, 14% of T-replete cord blood, and 2% of T-depleted PBSC (P = .73). Higher incidence of viremia (P < .001) and delayed CD3 reconstitution (P = .003) were observed after T-depleted graft HCT. These data indicate that mismatched donor transplant after TCRαβ/CD19 depletion represents an excellent alternative for younger children with IEI in need of an allograft.

摘要

造血细胞移植(HCT)已成为越来越多先天性免疫缺陷(IEI)的标准治疗方法。本报告首次比较了 2014 年至 2019 年间接受首次 HCT 的 IEI 儿童中,使用阿仑单抗的 T 细胞完全(即 T 完全)HLA 匹配移植物(n=117)和使用 T 细胞受体-αβ(TCRαβ)/CD19 耗竭(n=47)的 T 细胞耗竭(即 T 耗竭)HLA 不匹配移植物的移植结果。除 DNA 修复障碍患者外,所有患者均接受基于三氟胸苷的预处理。对于 T 完全移植物,干细胞来源为 25 例(21%)患者的骨髓、85 例(73%)患者的外周血干细胞(PBSC)和 7 例(6%)患者的脐带血。TCRαβ/CD19 耗竭在 45 例半相合父母供者和 2 例不合亲缘无关供者的 PBSC 上进行。整个队列的 3 年总生存率(OS)和无事件生存率分别为 85%(77%-90%)和 79%(69%-86%)。根据移植时的年龄进行分析,在年龄较小的患者(HCT 时<5 岁)中,T 完全移植物(88%;76%-94%)和 T 耗竭移植物(87%;64%-96%)的 3 年 OS 相当。对于年龄较大的患者(>5 岁),T 耗竭移植物的 OS 明显低于 T 完全移植物(55%;23%-78%)(P=0.03)。T 完全骨髓、T 完全 PBSC、T 完全脐带血中观察到 3 级至 4 级急性移植物抗宿主病的发生率分别为 8%、7%、14%,T 耗竭 PBSC 中为 2%(P=0.73)。T 耗竭移植物 HCT 后观察到病毒血症发生率更高(P<0.001)和 CD3 重建延迟(P=0.003)。这些数据表明,TCRαβ/CD19 耗竭后的 mismatched 供体移植是需要同种异体移植物的 IEI 年幼儿童的极佳选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/00a3/8864655/2a82a1dbebde/advancesADV2020004072absf1.jpg

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