title: Transplacental maternal engraftment and posttransplantation graft-versus-host disease in children with severe combined immunodeficiency.
abstract: Graft-versus-host disease (GVHD) is a complication of allogeneic hematopoietic stem cell transplantation (HSCT). Transplacental maternal engraftment (TME), the presence of maternal T cells in peripheral blood before transplantation, is detectable in a significant proportion of patients with severe combined immunodeficiency (SCID). Although the presence of TME is associated with a decreased risk of rejecting a maternal graft, it is unknown whether TME plays a role in development of GVHD after HSCT.
  
  
  
  The purpose of this study was to determine whether the presence of pretransplantation TME is associated with posttransplantation GVHD in patients with SCID.
  
  
  
  This was an institutional retrospective review of 74 patients with SCID undergoing transplantation between 1988 and 2014. The incidence of acute graft-versus-host disease (aGVHD) was compared in patients with versus those without TME. Confounding variables, such as donor type and conditioning regimen, were included in a multivariate regression model.
  
  
  
  TME was identified in 35 of 74 children. Post-HSCT aGVHD developed with an incidence of 57.1% versus 17.9% in those without TME (P < .001). In univariate analysis donor type (mother) and GVHD prophylaxis (T-cell depletion) were also significant predictors of aGVHD. In multivariate analysis TME and chemotherapy conditioning were independent risk factors for the development of aGVHD (relative risk, 2.75, P = .006 and relative risk, 1.42, P = .02, respectively).
  
  
  
  TME independently predicts the development of posttransplantation aGVHD, even when controlling for donor type and conditioning used. The presence of TME should be considered when assessing the risk of aGVHD in patients with SCID and designing the approach for GVHD prophylaxis.
authors.affiliation: Department of Pediatrics, Division of Pediatric Allergy, Immunology, & Bone Marrow Transplantation, University of California, San Francisco, Calif. Electronic address: Justin.wahlstrom@ucsf.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Wahlstrom
authors.affiliation: Department of Pediatrics, Division of Pediatric Allergy, Immunology, & Bone Marrow Transplantation, University of California, San Francisco, Calif.
authors.forename: Kiran
authors.initials: K
authors.lastname: Patel
authors.affiliation: University of California San Francisco/University of California Berkeley Joint Medical Program, San Francisco, Calif.
authors.forename: Erik
authors.initials: E
authors.lastname: Eckhert
authors.affiliation: Department of Surgery, Immunogenetics and Transplantation Laboratory, University of California, San Francisco, Calif.
authors.forename: Denice
authors.initials: D
authors.lastname: Kong
authors.affiliation: Department of Pediatrics, Division of Pediatric Allergy, Immunology, & Bone Marrow Transplantation, University of California, San Francisco, Calif.
authors.forename: Biljana
authors.initials: B
authors.lastname: Horn
authors.affiliation: Department of Pediatrics, Division of Pediatric Allergy, Immunology, & Bone Marrow Transplantation, University of California, San Francisco, Calif.
authors.forename: Morton J
authors.initials: MJ
authors.lastname: Cowan
authors.affiliation: Department of Pediatrics, Division of Pediatric Allergy, Immunology, & Bone Marrow Transplantation, University of California, San Francisco, Calif.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Dvorak
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000209:etiology; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008212:Lymphocyte Depletion; D008297:Male; D008431:Maternal-Fetal Exchange / Q000276:immunology*; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D016511:Severe Combined Immunodeficiency / Q000453:epidemiology* / Q000628:therapy; D013601:T-Lymphocytes / Q000276:immunology*; D023001:Transplantation Tolerance; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens
keywords: Severe combined immunodeficiency; conditioning; engraftment; graft-versus-host; graft-versus-host disease; haploidentical; hematopoietic stem cell transplantation; maternal; transplant