Table 2.
Interventions and outcome after CD34-selected, T-cell–depleted alternative donor stem cell transplant
| Patient ID | DLI CD3+ cell dose (×104/kg) (prophylactic/therapeutic) | Day after HSCT DLI given | MTX duration (days) | 4 wk after HSCT donor chimerism | 3 mo after HSCT donor chimerism | 6 mo after HSCT donor chimerism | 12 mo after HSCT donor chimerism | aGVHD (day after HSCT) | cGVHD | Major complications | Follow-up (months) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1 (T) | +65 | N/A | 99 | 97 | 100 | 100 | None | None | Septic arthritis of prosthetic hip | 60+ |
| 2 | 2.5 (T), 5 (T) | +44, +70 | N/A | 94 | 85 | 100 | N/A | Grade I after HSCT; grade IV after DLI #2 (+10, +86) | None | PTLD, TMA, PRES, renal failure, seizures, Aspergillosis | 10 |
| 3 | 3 (P) | +35 | 24 | 98 | 99 | 100 | 97 | None | None | None | 60+ |
| 4 | 4 (P) | +33 | 80 | 94 | 98 | 96 | 95 | None | None | PRES, seizure | 51+ |
| 5 | 0.1 (T)* | +35 | N/A | 100 | 77 | 87 | 92 | None | None | PTLD | 50+ |
| 6 | 4 (P) | +33 | 80 | 98 | 51 | N/A | 97† | None | None | PRES, acquired aplastic anemia, second HSCT† | 49+ |
| 7 | 5 (P) | +35 | 80 | 100 | 100 | 100 | 100 | None | None | None | 28+ |
| 8 | 5 (P) | +34 | 80 | 100 | 100 | 100 | 100 | None | None | PTLD | 15+ |
| 9 | 4 (P) | +35 | 80 | 100 | 100 | 100 | 100 | None | None | None | 15+ |
| 10 | 5 (P) | +40 | 80 | 100 | 100 | 100 | 100 | Grade I (+127), grade II (+149) | Extensive, skin | Hemorrhagic cystitis caused by BKV | 14+ |
aGVHD, acute graft-versus-host disease; BKV, BK virus; cGVHD, chronic graft-versus-host disease; DLI, donor lymphocyte infusion; HSCT, hematopoietic stem cell transplant; MTX, methotrexate; N/A not applicable; PRES, posterior reversible leukoencephalopathy; PTLD, posttransplant lymphoproliferative disorder; TMA, thrombotic microangiopathy. Chimerism is on whole blood. The last 3 patients in the table received rituximab 200 mg/m2 on the day of DLI because of autoimmunity seen in patients transplanted with the same approach for diseases other than SCD. For follow-up, a + means that the patient is surviving.
One patient received a very low dose DLI and EBV-specific third-party cytotoxic T lymphocytes.
Second transplant from sickle trait negative half-brother (HLA 5/10) with CD34+ cell dose of 20.3 × 106/kg and 0.3 × 104 CD3+/kg on day +210 after first transplant. Transplant conditioning regimen was pentostatin 1.5 mg/m2 × 3 d, rabbit antithymocyte globulin 2 mg/kg × 4 d, and total lymphoid irradiation 400 cGy. Twelve months after HSCT donor chimerism refers to the second donor.