Failure to Prevent Severe Graft-Versus-Host Disease in Haploidentical Hematopoietic Cell Transplantation with Post-Transplant Cyclophosphamide in Chronic Granulomatous Disease

• Published in: Journal of clinical immunology 2020-05, Vol.40 (4), p.619-624
• Main Authors: Parta, Mark, Hilligoss, Dianne, Kelly, Corin, Kwatemaa, Nana, Theobald, Narda, Zerbe, Christa S., Holland, Steven M., Malech, Harry L., Kang, Elizabeth M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biomedical and Life Sciences; Biomedicine; Busulfan; Chimerism; Chronic granulomatous disease; Cyclophosphamide; Cyclophosphamide - therapeutic use; Cystitis; Disease Progression; Female; Fludarabine; Graft vs Host Disease - diagnosis; Graft vs Host Disease - etiology; Graft-versus-host reaction; Granulomatous Disease, Chronic - mortality; Granulomatous Disease, Chronic - therapy; Hematopoietic Stem Cell Transplantation; Hemorrhage; Hemorrhagic cystitis; Humans; Immunology; Immunosuppressive Agents - therapeutic use; Infections; Infectious Diseases; Internal Medicine; Male; Medical Microbiology; Original Article; Peripheral blood; Postoperative Complications - diagnosis; Prophylaxis; Radiation; Rapamycin; Stem cell transplantation; Survival Analysis; Transplantation; Transplantation Conditioning - methods; Transplantation, Haploidentical; Transplants & implants; Treatment Failure; Viral infections; Young Adult
• ISSN: 0271-9142; 1573-2592; 1573-2592
• DOI: 10.1007/s10875-020-00772-z

Purpose Haploidentical related donor (HRD) transplantation was performed in 7 recipients with chronic granulomatous disease (CGD) who had no matched-related or unrelated donor. Methods Peripheral blood cell (PBC) products were used with a conditioning regimen consisting of low-dose cyclophosphamide, fludarabine, total body irradiation, and busulfan. Graft-versus-host disease (GVHD) prophylaxis consisted of high-dose post-transplant cyclophosphamide and sirolimus. Recipients were ages 14–26 years, and 3 had severe infections active at transplant. Results All 7 recipients achieved full engraftment with complete donor chimerism early in the post-transplant period. Acute GVHD occurred in all cases and was grade 3 or steroid refractory in 3. Two patients with steroid-refractory GVHD died. Three patients with severe infectious complications active at transplant, 1 Nocardia pneumonia and 2 extensive invasive fungal infections), survived and were cured of their infection at last follow-up. Bacterial disease occurred post-transplant in all recipients, and viral infections/reactivation were common, including 4 cases of BK virus–associated hemorrhagic cystitis. Conclusions Seven patients with CGD achieved rapid and full-donor engraftment from HRDs utilizing PBCs and a conditioning regimen with PTCy and sirolimus GVHD prophylaxis. However, the incidence of grade 3 and steroid-refractory GVHD was high and led to 2 deaths. Patients with active infections at transplant had successful transplant courses and were cured of their disease. Although there was an initial success with this regimen, the cumulative experience does not support its use in CGD due to an unacceptable rate of severe GVHD.