Matched Family Donor Lymphocyte Infusions as First Cellular Therapy for Patients with Severe Primary T-cell Deficiencies

Biol Blood Marrow Transplant. 2020 Oct 3;S1083-8791(20)30630-3. doi: 10.1016/j.bbmt.2020.09.037. Online ahead of print.

Abstract

Patients with primary immunodeficiencies caused by severe defects in T-cell immunity are at risk of acquiring life-threatening infections. Cellular therapies are necessary to establish normal T-cell function and to allow for long-term survival. This is most commonly achieved by hematopoietic stem cell transplantation (HSCT) but the outcome of this procedure is impaired if active infections are present at the time of HSCT. Donor lymphocyte infusions (DLI) are a well-established therapeutic strategy following HSCT to treat viral infections, to improve donor cell engraftment or to achieve graft versus leukemia activity in malignant disease. Here we present a cohort of six patients with primary T-cell deficiencies who received transfusions of unselected mature donor lymphocytes prior and not directly related to allogeneic HSCT. DLIs obtained from the peripheral blood of HLA-identical (10/10) family donors were transfused without prior conditioning to treat or to prevent life-threatening infections. All patients are alive with a follow-up of 0.5 to 16.5 years after the initial T-cell administration. Additional cellular therapies were administered in 5/6 patients at 0.8 to 15 months after the first DLI. Mild cutaneous graft-versus-host disease (GvHD, ≤ stage 2) was observed in 3/6 patients and resolved spontaneously. We provide evidence that unselected HLA-identical DLIs can effectively prevent or contribute to overcome infections with a limited risk for GvHD in T-cell deficient patients. The T-cell system established by this readily available source can provide T-cell function for years and can serve as a bridge to additional cellular therapies or -in specific conditions- as definite treatment.

Keywords: HSCT; T-cell deficiency; T-cell reconstitution; donor lymphocyte transfusion; matched family donor; opportunistic infection.