title: Regulatory T-cell recovery in recipients of haploidentical nonmyeloablative hematopoietic cell transplantation with a humanized anti-CD2 mAb, MEDI-507, with or without fludarabine.
abstract: OBJECTIVE
  We have evaluated T-cell reconstitution and reactivity in patients receiving nonmyeloablative haploidentical hematopoietic cell transplantation (HCT) protocols involving an anti-CD2 monoclonal antibody (MEDI 507) to treat chemorefractory hematopoietic malignancies.
  
  
  METHODS
  Three cohorts of four patients each and one cohort of six patients received one of four Medi-507-based regimens, all of which included cyclophosphamide, thymic irradiation, and a short posttransplantation course of cyclosporine.
  
  
  RESULTS
  Following marked T-cell depletion, initially recovering CD4 and CD8 T cells were mainly memory-type cells. A high percentage of CD4 T cells expressed high levels of CD25 in recipients of all protocols, except the only protocol to include fludarabine, early post-HCT. CD25 expression varied inversely with T-cell concentrations in blood. CD25(high) CD4 T cells expressed Foxp3 and cytotoxic T-lymphocyte-associated protein 4, indicating that they were regulatory T cells (Treg).
  
  
  CONCLUSIONS
  Fludarabine treatment prevents Treg enrichment after haploidentical nonmyeloablative stem cell transplantation, presumably by depleting recipient Tregs. In vitro analyses of allorecognition were consistent with a cytokine-mediated rejection process in one case and in another provided proof of principle that mixed chimerism achieved without graft-vs-host disease induces donor- and recipient-specific tolerance. More reliable achievement of this outcome could provide a promising strategy for organ allograft tolerance induction.
authors.affiliation: Transplantation Biology Research Center, Bone Marrow Transplantation Section, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02129, USA.
authors.forename: Juanita
authors.initials: J
authors.lastname: Shaffer
authors.forename: Jean
authors.initials: J
authors.lastname: Villard
authors.forename: Terry K
authors.initials: TK
authors.lastname: Means
authors.forename: Stephen
authors.initials: S
authors.lastname: Alexander
authors.forename: David
authors.initials: D
authors.lastname: Dombkowski
authors.forename: Bimalangshu R
authors.initials: BR
authors.lastname: Dey
authors.forename: Steven
authors.initials: S
authors.lastname: McAfee
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Susan
authors.initials: S
authors.lastname: Saidman
authors.forename: Frederic I
authors.initials: FI
authors.lastname: Preffer
authors.forename: David H
authors.initials: DH
authors.lastname: Sachs
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Spitzer
authors.forename: Megan
authors.initials: M
authors.lastname: Sykes
mesh_terms: D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D061067:Antibodies, Monoclonal, Humanized; D015703:Antigens, CD / Q000032:analysis; D000943:Antigens, Differentiation / Q000032:analysis; D018801:CD2 Antigens / Q000276:immunology; D060908:CTLA-4 Antigen; D051858:Forkhead Transcription Factors / Q000032:analysis; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007371:Interferon-gamma / Q000235:genetics; D050378:T-Lymphocytes, Regulatory / Q000502:physiology*; D016212:Transforming Growth Factor beta / Q000235:genetics; D018183:Transplantation Chimera; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000494:pharmacology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D015703:Antigens, CD; D000943:Antigens, Differentiation; D018801:CD2 Antigens; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors; D016212:Transforming Growth Factor beta; D007371:Interferon-gamma; D014740:Vidarabine; C544394:siplizumab; C024352:fludarabine