Rapid T‐cell chimerism switch and memory T‐cell expansion are associated with pre‐engraftment immune reaction early after cord blood transplantation

Abstract

Rapid T-cell chimerism switch and memory T-cell expansion are associated with pre-engraftment immune reaction early after cord blood transplantation Cord blood (CB) contains immature immune cells and is thought to be less active in inducing allogeneic immune reaction than other sources of stem cells. However, a high incidence of immune-mediated complications has been reported, such as pre-engraftment immune reaction (PIR) and haemophagocytic syndrome (HPS) early after cord blood transplantation (CBT) (Kishi et al, 2005;Narimatsu et al, 2007;Frangoul et al, 2009;Takagi et al, 2009;Patel et al, 2010). In addition, we reported that human leucocyte antigen (HLA) disparity in the graft-versus-host (GVH) direction adversely affected engraftment kinetics when single calcineurin inhibitors were used for GVH disease (GVHD) prophylaxis ). These observations suggested that the GVH reaction plays a critical role in engraftment. Here, we report the engraftment kinetics of donor-derived T cells using a multicolour flow cytometry-based method (HLAFlow method) (Watanabe et al, 2008) and also describe the results of naïve/memory T-cell phenotype analyses early after CBT.Between November 2009 and September 2010, 73 adult patients underwent single-unit CBT at Toranomon hospital. This study reports 41 patients who were eligible for chimerism analysis using the HLA-Flow method and survived more than 14 d after CBT. Characteristics of the patients and CB are summarized in Table SI. All patients provided written informed consent, and the study was conducted in accordance with institutional review board requirements. Peripheral blood was collected at 1, 2, 3, 4, and 8 weeks after CBT. Anti-HLA monoclonal antibodies in combination with lineage-specific antibodies were used to analyse the lineagespecific chimerism as previously reported (Watanabe et al, 2008). Anti-HLA antibodies specific for donor and recipient HLA in all patients are summarized in Table SII. At 2, 4, and 8 weeks after CBT, T-cell subsets were analysed using the following monoclonal antibodies: peridinin-chlorophyllprotein -cyanin 5Á5 (PerCP-Cy5Á5)-CD8, phycoerythrincyanin 7 (PE-Cy7)-CCR7, allophycocyanin (APC)-CD4, APC-Cy7-CD3 (BD Pharmingen, San Jose, CA, USA), and Pacific Blue-CD45RA (CALTAG, Carlsbad, CA, USA Fig 1B. Of 41 enrolled patients, 37 achieved neutrophil engraftment at a median of 19 d (range, 13-38 d). Thirty-nine patients achieved donor-dominant T-cell chimerism (>90%) by 3 weeks after CBT, whereas the remaining two patients, with recipient-dominant T-cell chimerism (>90%) at every point tested, developed graft failure because of early relapse (day 14 post-transplant) and rejection, respectively. Among the 39 patients who achieved donor-dominant T-cell chimerism, two died before engraftment due to non-relapse causes on day 28 (infection) and day 25 (diffuse alveolar haemorrhage), respectively. Among those with donor-dominant chimerism, 24 (63%) of 38 evaluable patients developed PIR at a median of 8 (6-11) days after CBT. Patients who achieved donor-dom...

Early lymphocyte recovery predicts clinical outcome after HSCT with mycophenolate mofetil prophylaxis in the Japanese population

“…Previous reports have indicated that donor lymphocyte reconstitution is identified approximately 2 weeks after HSCT [26,27]. In the present study, lymphocyte recovery in the low ALC group was delayed starting at day 10, although it normalized at 3 months after HSCT.…”

Complete Donor T Cell Chimerism Predicts Lower Relapse Incidence after Standard Double Umbilical Cord Blood Reduced-Intensity Conditioning Regimen Allogeneic Transplantation in Adults

“…Among factors that could influence outcomes after dUCB allotransplant in adults, chimerism has been poorly investigated, thus far. Indeed, if a favorable impact of full donor chimerism on hematopoietic recovery or pre-engraftment syndrome has been already reported, no data regarding influence of mixed versus full TCC chimerism on long-term outcomes are yet available after dUCB RIC transplantations in adults [15,16].…”

“…Therapeutic strategies to treat post-HSCT relapse historically consisted of withdrawal of immunosuppression or donor lymphocyte infusions, though several studies have shown efficacy in treating relapsed CML or Ph þ ALL with TKIs [8][9][10][11][12][13][14][15]. An increasing number of studies have also evaluated the prophylactic use of TKIs after transplantation in high-risk patients, including those with detectable BCR-ABL at the time of transplantation, though there are very limited data to guide their selection and administration [16][17][18][19].…”

Single cord blood transplantation in Japan; expanding the possibilities of CBT

“…Serum values for inflammatory cytokines such as IL-6 or IL-5, are elevated around the time of PIR onset [46,47]. We previously showed that rapid T cell chimerism switches to the donor type, and phenotypic conversion from naïve to memory T cells are significantly associated with the development of PIR [48]. Gutman et al also reported that CD8 + T cells predominately expressed effector memory or effector phenotype and produced IFN-γ in response only to non-engrafted units early after double-unit CBT, reflecting a specific immune response of the dominant, against the non-engrafted units [49].…”