[Dialyzed leukocyte extracts for the treatment of recurrent and severe infections in pediatric patients with cellular immunodeficiency: 15 years of experience]

Rev Alerg Mex. Jan-Mar 2019;66(1):27-37. doi: 10.29262/ram.v66i1.531.
[Article in Spanish]

Abstract

Background: Dialyzable leukocyte extracts (DLE) have been used to treat several cellular immunodeficiency.

Objective: To review the experience of a tertiary hospital in the use of DLE for the treatment of recurrent or severe infections in children with acquired cellular immunodeficiency not due to HIV.

Methods: We reviewed the medical records of all children who received treatment with EDL of human or bovine origin between 1986 and 2000 to detect recurrent or severe infections without response to a specific antimicrobial therapy and with a quantitative or qualitative deficit in the cellular immune response. The dose of DLE was adjusted according to the percentage of T lymphocytes; the evolution of the patient was evaluated retrospectively for 5 years, the immune response was evaluated by subpopulation of lymphocytes and intradermal tests and inhibition of the leukocyte migration assay (LIF) to PPD, coccidioidin, varidase and candidin.

Results: 150 children received DLE, age 7.0 ± 5.9 years. The most frequent indications included upper respiratory tract (71%), lower respiratory tract (43%), gastrointestinal tract (15%), urinary tract (15%) and neurological infections (4%) and coccidioidomycosis (3%). After starting the DLE, the numbers of T lymphocytes, LIF to PPD and varidase (> 20%) and the intradermal induration of the test increased (p <0.001). In 6 patients (4%) recurrences of respiratory and gastrointestinal tract infections were observed, which resolved, no adverse effects attributable to the DLE were reported.

Conclusions: The use of DLE for recurrent or severe infectious processes in children with cellular immune deficit improved the clinical evolution and the immunological parameters evaluated without adverse effects attributable to their use.

Antecedentes: Los extractos dializados de leucocitos (EDL) han sido utilizados en el tratamiento de diversos defectos de la inmunidad celular. Objetivo: Revisar la experiencia en el uso de EDL para tratar infecciones recurrentes o severas en niños con inmunodeficiencia celular adquirida no debida a virus de la inmunodeficiencia oportuna. Métodos: Se revisaron expedientes de niños tratados con EDL humano o bovino entre 1986 y 2000, por infecciones recurrentes o severas sin respuesta a antimicrobianos y con déficit en la respuesta inmune celular. La dosis se ajustó por el porcentaje de poblaciones de linfocitos T. En el seguimiento a cinco años, la respuesta inmune se evaluó por subpoblaciones de linfocitos, intradermorreacción e inhibición de la migración de leucocitos (LIF) a PPD, coccidioidina, varidasa y candidina. Resultados: 150 niños recibieron EDL, edad 7.0 ± 5.9 años. Las indicaciones más frecuentes incluyeron infección respiratoria superior (71 %), respiratoria inferior (43 %), gastrointestinal (15 %), urinaria (15 %), neuroinfección (4 %) y coccidioidomicosis (3 %). Se incrementaron los linfocitos T, el LIF a PPD y varidasa (> 20 %), así como la induración en pruebas de intradermorreacción (p < 0.001). Se resolvieron las infecciones que se presentaron (4 %). No se reportaron efectos adversos. Conclusiones: El uso de EDL mejoró los parámetros inmunológicos y la evolución clínica en niños con déficit inmune celular.

Keywords: Cellular immunodeficiency; Extracted dialyzable leukocytes; Immunomodulatory; Immunotherapy; Transfer factors.

MeSH terms

  • Child
  • Female
  • Humans
  • Immunologic Deficiency Syndromes / complications*
  • Infections / immunology*
  • Infections / therapy*
  • Male
  • Recurrence
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors
  • Transfer Factor / therapeutic use*

Substances

  • Transfer Factor