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Higher CD45RA+ Regulatory T Cells in the Graft Improves Outcome in Younger Patients Undergoing T Cell-Replete Haploidentical Transplantation: Where Donor Age Matters.
Jaiswal, Sarita Rani; Bhakuni, Prakash; Joy, Aby; Murli, Nisha; Rajoreya, Ashok; Chakrabarti, Aditi; Chakrabarti, Suparno.
Afiliación
  • Jaiswal SR; Manashi Chakrabarti Foundation, Kolkata, India; Department of Blood and Marrow Transplantation and Hematology, Dharamshila Narayana Superspeciality Hospital and Research Centre, New Delhi, India. Electronic address: drsaritaranij@gmail.com.
  • Bhakuni P; Department of Blood and Marrow Transplantation and Hematology, Dharamshila Narayana Superspeciality Hospital and Research Centre, New Delhi, India.
  • Joy A; Department of Blood and Marrow Transplantation and Hematology, Dharamshila Narayana Superspeciality Hospital and Research Centre, New Delhi, India.
  • Murli N; Department of Blood and Marrow Transplantation and Hematology, Dharamshila Narayana Superspeciality Hospital and Research Centre, New Delhi, India.
  • Rajoreya A; Department of Blood and Marrow Transplantation and Hematology, Dharamshila Narayana Superspeciality Hospital and Research Centre, New Delhi, India.
  • Chakrabarti A; Manashi Chakrabarti Foundation, Kolkata, India.
  • Chakrabarti S; Manashi Chakrabarti Foundation, Kolkata, India; Department of Blood and Marrow Transplantation and Hematology, Dharamshila Narayana Superspeciality Hospital and Research Centre, New Delhi, India.
Biol Blood Marrow Transplant ; 24(10): 2025-2033, 2018 10.
Article en En | MEDLINE | ID: mdl-29906568
To understand the phenomenon of early alloreactivity (EA) in younger children undergoing post-transplantation cyclophosphamide (PTCy)-based haploidentical transplantation, we studied the graft composition and the immune reconstitution in 32 consecutive patients (aged 2 to 25 years) undergoing PTCy and T cell costimulation blockade based peripheral blood stem cell transplantation with emphasis on CD45RA+ subset of regulatory T cells (Tregs). All but 1 engrafted, and 14 patients experienced EA (acute graft-versus-host disease grades II to IV, n = 8; and post-transplantation hemophagocytic syndrome, n = 6) with a cumulative incidence of 43.7%; 42% developed mild chronic graft-versus-host disease. The overall survival was 70.2% with a nonrelapse mortality of 16.8% at a median of 19 months. Age < 10 years, donor age > 45 years, and poor recovery of Tregs correlated with EA. Not Tregs but higher CD45RA+ Tregs in the graft was associated with less EA (11.7% versus 32.5%, P = .0001). Higher donor age correlated with a lower CD45RA+ Tregs in the graft (P = .01). However, only higher CD45RA+ Treg percentage in the graft favorably impacted EA as well as nonrelapse mortality and overall survival. Our study demonstrates a critical role for CD45RA+ Tregs in determining EA and outcome after PTCy-based haploidentical peripheral blood stem cell transplantation, and the age-related physiologic decline in this population might be responsible for adverse impact of donor age.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Linfocitos T Reguladores / Neoplasias Hematológicas / Donadores Vivos / Ciclofosfamida / Trasplante de Células Madre de Sangre Periférica Tipo de estudio: Observational_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: Biol Blood Marrow Transplant Asunto de la revista: HEMATOLOGIA / TRANSPLANTE Año: 2018 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Linfocitos T Reguladores / Neoplasias Hematológicas / Donadores Vivos / Ciclofosfamida / Trasplante de Células Madre de Sangre Periférica Tipo de estudio: Observational_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: Biol Blood Marrow Transplant Asunto de la revista: HEMATOLOGIA / TRANSPLANTE Año: 2018 Tipo del documento: Article