CD3/CD19 Depletion for T-cell Reduction of Allogeneic Transplants: Mostly Efficient, but not Robust

Authors

Eliza Wiercinska¹, Erhard Seifried^{1, 2,} , Halvard Bonig^{1, 2, 3, *,}

¹German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt a.M., Germany

²Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt a.M., Germany

³Department of Medicine/Division of Hematology, University of Washington, Seattle, WA, USA

^*Corresponding author. Email: h.boenig@blutspende.de; hbonig@uw.edu

DOI

10.2991/chi.k.210725.001How to use a DOI?

Keywords

Immunomagnetic depletion; CliniMACS; haplo-identical transplantation; TCRαβ/CD19 depletion; graft-versus-host disease; graft failure

Abstract

Aggressive T-cell depletion, in vitro or in vivo, is a prerequisite for survival of haplo-identical stem cell transplantation. The classical T-cell-depleted transplant, immunomagnetically enriched CD34+ cells, is very safe with respect to graft-versus-host reactivity, but associated with very high transplant-related and relapse mortality with an overall probability of survival of only 20%. Protocols for T- and B-cell depletion were therefore developed, reasoning that transplantation of the majority of Natural Killer (NK) cells and the substantial dose of residual T-cells might improve survival, which was, in principle, confirmed. Anecdotal reports of frequent failure to achieve adequate T-cell depletion prompted review of the aggregate data for transplant quality at our center. The first observation is the relative paucity of combined CD3/CD19 depletion processes as PTCy protocols have made inroads, 13 depletions in 8 years. Median T- and B-cell log-depletion were −3.89 and −1.92, respectively; instead of, CD34+ cell recovery was generally high (median 92%), as was NK-cell recovery (median 52%). However, the process failed to yield satisfactory T- and B-cell depletion in two out of 13 preparations, of which one product could be rescued by a second round of depletion, at the expense of CD34+ cell recovery. In our hands, the process is thus insufficiently robust for routine clinical use. Assuming similar observations in other centers, this may explain implementation of alternative protocols, such as TCRαβ/CD19 depletion or transplantation of unmanipulated grafts with subsequent in vivo depletion.

Copyright

© 2021 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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TY  - JOUR
AU  - Eliza Wiercinska
AU  - Erhard Seifried
AU  - Halvard Bonig
PY  - 2021
DA  - 2021/08/02
TI  - CD3/CD19 Depletion for T-cell Reduction of Allogeneic Transplants: Mostly Efficient, but not Robust
JO  - Clinical Hematology International
SP  - 103
EP  - 107
VL  - 3
IS  - 3
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.k.210725.001
DO  - 10.2991/chi.k.210725.001
ID  - Wiercinska2021
ER  -