High-dose post-transplant cyclophosphamide impairs gammadelta T-cell reconstitution after haploidentical haematopoietic stem cell transplantation using low-dose antithymocyte globulin and peripheral blood stem cell graft (Équipe Mohty)

03 - Octobre - 2020

Nicolas Stocker, Béatrice Gaugler, Myriam Labopin, Agathe Farge, Yishan Ye, Laure Ricard, Eolia Brissot, Remy Dulery, Simona Sestili, Giorgia Battipaglia, Clemence Mediavilla, Annalisa Paviglianiti, Anne Banet, Van De Zoe Wyngaert, Tounes Ledraa, Mohamad Mohty, Florent Malard,

Clin Transl Immunology. 2020;9(9):e1171

OBJECTIVES: Haploidentical haematopoietic cell transplantation (Haplo-HCT) using peripheral blood stem cell (PBSC) grafts and post-transplant cyclophosphamide (PTCy) is being increasingly used; however, data on immunological reconstitution (IR) are still scarce.

METHODS: This retrospective study evaluated T-cell immunological reconstitution in 106 adult patients who underwent allogeneic haematopoietic cell transplantation for haematologic malignancies between 2013 and 2016.

RESULTS: At D30, while conventional T cells reached similar median counts in Haplo-HCT recipients (n = 19) and controls (n = 87), gammadelta and Vdelta2(+) T-cell median counts were significantly lower in Haplo-HCT recipients and it persists at least until D360 for Vdelta2(+) T cells. PTCy induces a significant reduction in early gammadelta and Vdelta2(+) T-cell proliferation at D 7. At one year, the rate of increase in Epstein-Barr virus (EBV) viral load was significantly higher in Haplo-HCT recipients as compared to controls (61% versus 34%, P = 0.02). In multivariate analysis, a higher gammadelta T-cell count (> 4.63 muL(-1)) at D30 was the only independent parameter significantly associated with a reduced risk of increase in EBV viral load (RR 0.34; 95% CI, 0.15-0.76, P = 0.009).

CONCLUSION: Immunological reconstitution of gammadelta T cells is significantly delayed after Haplo-HCT using PTCy and low-dose ATG and is associated with an increased risk of increase in EBV viral load.

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