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Immune Cytopenias after Ex Vivo CD34+-Selected Allogeneic Hematopoietic Cell Transplantation.

Authors
  • Scordo, Michael1
  • Hsu, Meier2
  • Jakubowski, Ann A3
  • Shah, Gunjan L3
  • Cho, Christina3
  • Maloy, Molly A4
  • Avecilla, Scott T5
  • Papadopoulos, Esperanza B3
  • Gyurkocza, Boglarka3
  • Castro-Malaspina, Hugo3
  • Tamari, Roni3
  • O'Reilly, Richard J6
  • Perales, Miguel-Angel3
  • Giralt, Sergio A3
  • Shaffer, Brian C3
  • 1 Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York. Electronic address: [email protected]
  • 2 Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York.
  • 3 Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
  • 4 Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
  • 5 Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
  • 6 Pediatric Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York.
Type
Published Article
Journal
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Publication Date
Jun 01, 2019
Volume
25
Issue
6
Pages
1136–1141
Identifiers
DOI: 10.1016/j.bbmt.2018.12.842
PMID: 30625387
Source
Medline
Keywords
Language
English
License
Unknown

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. Copyright © 2019 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

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