Escalated dose donor lymphocyte infusion treatment in patients with primary immune deficiencies after HSCT with reducedintensity conditioning regimen

Authors

Tahani Ali, Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
Maryam Behfar, Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
Rashin Mohseni, Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
Pourya Salajegheh, Department of Pediatric, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
Maged Kheder, Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
Faihaa Abou-Fakher, Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
Zeynab Nikfetrat, Pediatric Hematopoietic Stem Cell Transplant Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Fahimeh Jafari, Pediatric Hematopoietic Stem Cell Transplant Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Parisa Naji, Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
Amir Ali Hamidieh, Pediatric Cell and Gene Therapy Research Center, Tehran University of Medical Sciences, Tehran, IranFollow

Abstract

Objective/Background: Mixed chimerism is a major concern after allogenic hematopoietic stem cell transplantation (HSCT) using a reduced-intensity conditioning (RIC) regimen in primary immunodeficiencies (PIDs). A donor lymphocyte infusion (DLI) escalating dose regimen has been developed with the aim of reducing toxicity while preserving efficacy. However, the graft-versus-host disease (GvHD) development remains the most common and adverse effect of DLI and continues to be a limiting factor in its application, especially nonmalignant diseases such as PIDs. We prospectively evaluated PID patients after HSCT using RIC in Children s Medical Center, who were candidates for an escalating dose of DLI for MC from 2016 to 2018. Methods: With the median follow-up of 16.4 months, 12 patients (nine males and three females) with a median age of 3.72 years received DLI. The median number of DLI was 3.2 (range, 1–5), the maximum and total dose of DLIs administered per patient were 3.6 107 (range, 1–5) cells/kg CD3+ and 9.3 107 (range, 1–15) cells/kg CD3+ cells, respectively.

Results: Median donor chimerism at baseline before the DLIs was 41% (range, 11–73%), patients received DLIs at a median of 105 (range, 37–230) days and 52 (range, 3–168) days after the HSCT and onset of the MC, respectively. At the final assessment, six (54.5%) patients improved after DLIs at a median of 47.3 days. Conclusion: PID patients may benefit from DLI with an escalating dose regimen, but the GvHD development remains a concern during the DLI, and the optimum dose and frequency must be standardized.

Recommended Citation

Ali, Tahani; Behfar, Maryam; Mohseni, Rashin; Salajegheh, Pourya; Kheder, Maged; Abou-Fakher, Faihaa; Nikfetrat, Zeynab; Jafari, Fahimeh; Naji, Parisa; and Hamidieh, Amir Ali (2023) "Escalated dose donor lymphocyte infusion treatment in patients with primary immune deficiencies after HSCT with reducedintensity conditioning regimen," Hematology/Oncology and Stem Cell Therapy: Vol. 16 : Iss. 3 , Article 12.
Available at: https://doi.org/10.1016/j.hemonc.2021.06.002

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