Low-dose serotherapy improves early immune reconstitution after cord blood transplantation for primary immunodeficiencies.
Cord blood transplantation (CBT) is curative for many primary immunodeficiencies (PIDs) but is associated with risks of viral infection and graft-versus-host disease (GvHD). Serotherapy reduces GvHD but potentially increases the risk of viral infection by delaying immune reconstitution. Because many PID patients have pre-existing viral infections, the optimal dose of serotherapy is unclear. We performed a retrospective analysis in 34 consecutive PID patients undergoing CBT and compared immune reconstitution, viral infection, GvHD, mortality, and long-term immune function between high-dose (n = 11) and low-dose (n = 9) serotherapy. Serotherapy dose had no effect on neutrophil engraftment. Median CD3(+) engraftment occurred at 92.5 and 97 days for high- and low-dose serotherapy, respectively. The low-dose serotherapy group had higher CD3(+), CD4(+), and early thymic emigrant counts at 4 months compared with the high-dose group. GvHD severity and number of viral infections did not differ between serotherapy doses. Survival from the transplantation process was 90.9% for high-dose and 100% for low-dose groups. In conclusion, low-dose serotherapy enhanced T cell reconstitution and thymopoiesis during the first year after CBT with no increase in GvHD.
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Jonathan P
JP
Lane
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
Philippa T G
PT
Evans
Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Zohreh
Z
Nademi
Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Dawn
D
Barge
International Centre for Life, Newcastle upon Tyne, United Kingdom.
Anthony
A
Jackson
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Sophie
S
Hambleton
Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Terry J
TJ
Flood
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Andrew J
AJ
Cant
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Mario
M
Abinun
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
Mary A
MA
Slatter
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom. Electronic address: andrew.gennery@newcastle.ac.uk.
Andrew R
AR
Gennery
D000293:Adolescent; D000328:Adult; D002648:Child; D046528:Chimerism; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007116:Immunization, Passive / Q000379:methods*; D007153:Immunologic Deficiency Syndromes / Q000209:etiology; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous / Q000009:adverse effects*; D055815:Young Adult
Alemtuzumab; Cord blood transplantation; Immune reconstitution; Primary immunodeficiency; Serotherapy