Acute Neurological Involvement after Donor Lymphocyte Infusion for Post-Transplant Viral Infection: The Same Pattern of Novel Cancer Immunotherapy-Related CNS Toxicity?

Abstract

Early post-transplant is the critical phase for the success of hematopoietic stem cell transplantation (HSCT). New viral infections and the reactivations associated with complete ablation of the recipient’s T-cell immunity and inefficient reconstitution of the donor-derived system represent the main risks of HSCT. To date, the pharmacological treatments for post-HSCT viral infection-related complications have many limitations. Adoptive cell therapy (ACT) represents a new pharmacological strategy, allowing us to reconstitute the immune response to infectious agents in the post-HSC period. To demonstrate the potential advantage of this novel immunotherapy strategy, we report three cases of pediatric patients and the respective central nervous system complications after donor lymphocyte infusion.

Molecular Immunology in Hematological Disorders

“…Therefore, there is a close pathophysiological relationship between hematological diseases and the immune system, and the elucidation of these molecular mechanisms will advance the diagnosis and treatment of benign and malignant hematologic, infectious, and autoimmune diseases. Contemporary studies [ 1 , 2 , 3 , 4 , 5 , 6 ] have focused on the applications of molecular immunology in hematology, providing fresh insights into the molecular immunological mechanisms involved in the diagnosis and treatment of hematologic diseases.…”

“…Although these complications have been found to hinder the success of CAR-T cell therapy, it was unclear whether ICANS occurred after allogeneic hematopoietic stem cell transplantation. Marcuzzi et al [ 3 ] found that three pediatric patients treated with donor lymphocyte infusion for immunodeficiency-associated viral infections (Epstein–Barr virus in two, adenovirus in one) after allogeneic hematopoietic stem cell transplantation developed CRS and ICANS with increased TNF-α and IL-1b. Moreover, their study showed that treatment with the TNF-α inhibitor infliximab was effective in all three cases of ICANS.…”