Improved survival rate in T-cell depleted haploidentical hematopoietic cell transplantation over the last 15 years at a single institution

• Published in: Bone marrow transplantation (Basingstoke) Vol. 55; no. 5; pp. 929 - 938
• Main Authors: Mamcarz, Ewelina, Madden, Renee, Qudeimat, Amr, Srinivasan, Ashok, Talleur, Aimee, Sharma, Akshay, Suliman, Ali, Maron, Gabriela, Sunkara, Anusha, Kang, Guolian, Leung, Wing, Gottschalk, Stephen, Triplett, Brandon M.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.05.2020; Nature Publishing Group
• Subjects: 631/67/1059/2325; 692/699/67/1990; 692/700/1720; 692/700/565/2319; Antiretroviral drugs; CD45RA antigen; Cell Biology; Cell survival; Depletion; Diseases; Graft rejection; Graft-versus-host reaction; Grafting; Grafts; Health risks; Hematology; Hematopoietic stem cells; Histocompatibility antigen HLA; Immunological memory; Internal Medicine; Lymphocytes; Lymphocytes T; Malignancy; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Memory cells; Mortality; Prophylaxis; Public Health; Reduction; Relapse; Stem cell transplantation; Stem Cells; Survival; T cells; Transplantation; Transplants & implants; Viremia; Young adults
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-019-0750-7

T-cell depletion of an HLA-haploidentical (haplo) graft is often used to reduce the risk of graft-versus-host disease (GVHD), but the lack of donor T cells in the infused product may lead to graft failure, slow T-cell reconstitution, infections, and relapse. More selective T-cell depletion targeting CD45RA can effectively deplete naive T cells but preserve large numbers of memory T cells leading to robust engraftment of diverse T-cell populations and reduction of viremia in the early posttransplant period. Herein, we report the outcome of 143 pediatric and young adult hematologic malignancy patients receiving a first allogeneic hematopoietic cell transplantation (HCT) on six consecutive ex vivo T-cell depleted haploHCT protocols over the past 15 years at a single institution—including the first 50 patients on an active CD45RA-depleted haploHCT study in which patients also received NK-cells and pharmacological GvHD prophylaxis post transplant. Our data demonstrated an increase in the 3-year overall survival and event-free survival in nonchemorefractory recipients receiving CD45RA-depleted grafts (78.9% and 77.7%, respectively) compared with historic T-cell depleted haploHCT cohorts (46.7% and 42.7%, respectively, p  = 0.004, and 0.003). This improvement was primarily due to a reduction in transplant related mortality without significant increase in the rates of GVHD.