SCID genotype and 6-month posttransplant CD4 count predict survival and immune recovery.

Published

Journal Article

The Primary Immune Deficiency Treatment Consortium (PIDTC) performed a retrospective analysis of 662 patients with severe combined immunodeficiency (SCID) who received a hematopoietic cell transplantation (HCT) as first-line treatment between 1982 and 2012 in 33 North American institutions. Overall survival was higher after HCT from matched-sibling donors (MSDs). Among recipients of non-MSD HCT, multivariate analysis showed that the SCID genotype strongly influenced survival and immune reconstitution. Overall survival was similar for patients with RAG, IL2RG, or JAK3 defects and was significantly better compared with patients with ADA or DCLRE1C mutations. Patients with RAG or DCLRE1C mutations had poorer immune reconstitution than other genotypes. Although survival did not correlate with the type of conditioning regimen, recipients of reduced-intensity or myeloablative conditioning had a lower incidence of treatment failure and better T- and B-cell reconstitution, but a higher risk for graft-versus-host disease, compared with those receiving no conditioning or immunosuppression only. Infection-free status and younger age at HCT were associated with improved survival. Typical SCID, leaky SCID, and Omenn syndrome had similar outcomes. Landmark analysis identified CD4+ and CD4+CD45RA+ cell counts at 6 and 12 months post-HCT as biomarkers predictive of overall survival and long-term T-cell reconstitution. Our data emphasize the need for patient-tailored treatment strategies depending upon the underlying SCID genotype. The prognostic significance of CD4+ cell counts as early as 6 months after HCT emphasizes the importance of close follow-up of immune reconstitution to identify patients who may need additional intervention to prevent poor long-term outcome.

Full Text

Duke Authors

Cited Authors

  • Haddad, E; Logan, BR; Griffith, LM; Buckley, RH; Parrott, RE; Prockop, SE; Small, TN; Chaisson, J; Dvorak, CC; Murnane, M; Kapoor, N; Abdel-Azim, H; Hanson, IC; Martinez, C; Bleesing, JJH; Chandra, S; Smith, AR; Cavanaugh, ME; Jyonouchi, S; Sullivan, KE; Burroughs, L; Skoda-Smith, S; Haight, AE; Tumlin, AG; Quigg, TC; Taylor, C; Dávila Saldaña, BJ; Keller, MD; Seroogy, CM; Desantes, KB; Petrovic, A; Leiding, JW; Shyr, DC; Decaluwe, H; Teira, P; Gillio, AP; Knutsen, AP; Moore, TB; Kletzel, M; Craddock, JA; Aquino, V; Davis, JH; Yu, LC; Cuvelier, GDE; Bednarski, JJ; Goldman, FD; Kang, EM; Shereck, E; Porteus, MH; Connelly, JA; Fleisher, TA; Malech, HL; Shearer, WT; Szabolcs, P; Thakar, MS; Vander Lugt, MT; Heimall, J; Yin, Z; Pulsipher, MA; Pai, S-Y; Kohn, DB; Puck, JM; Cowan, MJ; O'Reilly, RJ; Notarangelo, LD

Published Date

  • October 25, 2018

Published In

Volume / Issue

  • 132 / 17

Start / End Page

  • 1737 - 1749

PubMed ID

  • 30154114

Pubmed Central ID

  • 30154114

Electronic International Standard Serial Number (EISSN)

  • 1528-0020

Digital Object Identifier (DOI)

  • 10.1182/blood-2018-03-840702

Language

  • eng

Conference Location

  • United States