Session Time: 4:30pm-6:00pm
Presentation Time: 5:18pm-5:30pm
Location: Room 210
Primary immunodeficiency patients may develop pulmonary complications and most are ineligible for either lung transplant or BMT due to futility. We report our first 2 subjects enrolled on NCT01852370 trial receiving tandem BOLT&BMT from the same deceased UNOS donor.
Case 1: 14 year old female with IL-7R SCID & recurrent pneumonia underwent BOLT from a 2/6 HLA antigen (1/8 allele level) matched donor. Marrow suspension prepared from T11-L4 VB was CD3+/CD19+ depleted(CliniMACS®) then frozen along with ~20 fold fewer TNC & CD34+ cells from the iliac crest. At 3m post-BOLT, she started BMT conditioning. A month later, the marrow was thawed and infused (5E+06 CD34+ cells/kg and 8E+04 T cells/kg). She engrafted with 100% donor cells. Due to persistent T cell lymphopenia (mostly host), she received DLI ~10w later (5E+04 T cells/kg).
DLI resulted in dominant donor T and B cell chimerism (Fig1A, B) unlike other subsets (Fig1C,D). BAL values exhibited different kinetics (Fig1).
T/B cells, TCR/BCR repertoires, and TREC exceeded pre-BMT values by 3-6m (Fig2A,B). BK virus specific T cells cleared viremia (Fig2C).
Mild skin GVHD was cleared in 2w with <1mg/kg prednisone. Serial lung biopsies have been negative for rejection up to now (5m off IST). At 18m post-BMT (2m post-IST withdrawal), circulating donor T cells were unresponsive to host DC while responded to 3rd party APC (Fig3). Tolerance towards host APC was Treg independent (Fig3).
Case 2: 38y/o female with CVID on ECMO underwent BOLT. She had 3 episodes of lung rejection before becoming eligible for BMT (1/8 match) 14 months later. She engrafted by day+12 with 95% whole blood chimerism but T cells of host origin that was treated with DLI.
Case 1 is the first in human to demonstrate durable engraftment, immune competence, and tolerance from deceased donor VB marrow matched only at a single class I MHC allele, providing proof of principle currently tested in adults.
CITATION INFORMATION: Szabolcs P., Chen X., Donnenberg A., Hill M., Rowan J., Mcintyre S., Kurland G., Barnum J., McDyer J. Immunity and Tolerance after Bilateral Orthotopic Lung Transplant (BOLT) in Tandem with a CD3+/CD19+ Depleted Vertebral Bone Marrow Transplant (BOLT+BMT) from 1 of 8 HLA-Matched Cadaveric Donors Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Szabolcs P, Chen X, Donnenberg A, Hill M, Rowan J, Mcintyre S, Kurland G, Barnum J, McDyer J. Immunity and Tolerance after Bilateral Orthotopic Lung Transplant (BOLT) in Tandem with a CD3+/CD19+ Depleted Vertebral Bone Marrow Transplant (BOLT+BMT) from 1 of 8 HLA-Matched Cadaveric Donors [abstract]. https://atcmeetingabstracts.com/abstract/immunity-and-tolerance-after-bilateral-orthotopic-lung-transplant-bolt-in-tandem-with-a-cd3-cd19-depleted-vertebral-bone-marrow-transplant-boltbmt-from-1-of-8-hla-matched-cadaveric-donors/. Accessed April 21, 2019.
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