Synapse - Immune cytopenias after ex vivo CD34+-selected allogeneic hematopoietic cell transplantation

Immune cytopenias after ex vivo CD34+-selected allogeneic hematopoietic cell transplantation Journal Article

Authors:	Scordo, M.; Hsu, M.; Jakubowski, A. A.; Shah, G. L.; Cho, C.; Maloy, M. A.; Avecilla, S. T.; Papadopoulos, E. B.; Gyurkocza, B.; Castro-Malaspina, H.; Tamari, R.; O'Reilly, R. J.; Perales, M. A.; Giralt, S. A.; Shaffer, B. C.
Article Title:	Immune cytopenias after ex vivo CD34+-selected allogeneic hematopoietic cell transplantation
Abstract:	Immune-mediated cytopenias (ICs), such as immune thrombocytopenia and immune hemolytic anemia, are among the adverse events after allogeneic hematopoietic cell transplantation (allo-HCT). Previous reports suggest that in vivo T cell depletion may increase the incidence of IC after allo-HCT. We evaluated whether a strategy that reduces functional donor T cells via ex vivo CD34+-selection associates with the development of IC in a cohort of 408 patients who underwent allo-HCT for hematologic malignancy. The cumulative incidence of IC at 6, 12, and 36 months after the 30-day landmark post-HCT was 3.4%, 4.9%, and 5.8%, respectively. Among 23 patients who developed IC, 7 died of relapse-related mortality and 4 of nonrelapse mortality. A median 2 types of treatment (range, 1 to 5) was required to resolve IC, and there was considerable heterogeneity in the therapies used. In univariable analyses, a hematologic malignancy Disease Risk Index (DRI) score of 3 was significantly associated with an increased risk of IC compared with a DRI of 1 or 2 (hazard ratio [HR], 4.12; P = .003), and IC (HR, 2.4; P = .03) was associated with increased risk of relapse. In a multivariable analysis that included DRI, IC remained significantly associated with increased risk of relapse (HR, 2.4; P = .03). Our findings show that IC events occur with relatively similar frequency in patients after ex vivo CD34+-selected allo-HCT compared with unmodified allo-HCT, suggesting that reduced donor T cell immunity is not causative of IC. Moreover, we noted a possible link between its development and/or treatment and increased risk of relapse. © 2019 American Society for Blood and Marrow Transplantation
Keywords:	adult; treatment outcome; aged; major clinical study; busulfan; fludarabine; mortality; splenectomy; rituximab; t lymphocyte; cd34 antigen; multiple myeloma; bleeding; relapse; cyclophosphamide; immunoglobulin; melphalan; retrospective study; thiotepa; hematologic malignancy; myeloablative conditioning; myelodysplastic syndrome; whole body radiation; cellular immunity; allogeneic hematopoietic stem cell transplantation; romiplostim; idiopathic thrombocytopenic purpura; corticosteroid; calcineurin inhibitor; ex vivo study; hematoma; cd34 selection; cytopenia; clofarabine; hematopoietic cell transplantation; subdural hematoma; human; male; female; article; immune thrombocytopenia; ex vivo cd34 selection; immune cytopenias; immune-mediated hemolytic anemia
Journal Title:	Biology of Blood and Marrow Transplantation
Volume:	25
Issue:	6
ISSN:	1083-8791
Publisher:	Elsevier Inc.
Date Published:	2019-06-01
Start Page:	1136
End Page:	1141
Language:	English
DOI:	10.1016/j.bbmt.2018.12.842
PUBMED:	30625387
PROVIDER:	scopus
PMCID:	PMC6559823
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85061143143&doi=10.1016%2fj.bbmt.2018.12.842&partnerID=40&md5=59341b725bc84335e6a7e2f87267c83d
Notes:	Source: Scopus