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Liu S, Huo F, Dai G, Wu J, Qin M, Mao H, Wang Q. Case Report: Immune reconstitution inflammatory syndrome after hematopoietic stem cell transplantation for severe combined immunodeficiency. Front Immunol 2022; 13:960749. [PMID: 36225916 PMCID: PMC9548620 DOI: 10.3389/fimmu.2022.960749] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/06/2022] [Indexed: 12/04/2022] Open
Abstract
We report a case of immune reconstitution inflammatory syndrome (IRIS) after hematopoietic stem cell transplantation (HSCT). The patient had sever bacillus Calmette–Guerin (BCG) vaccine–caused disseminated infection and had received allogeneic HSCT for X-linked severe combined immunodeficiency disease. After HSCT, complicated by treatment-responding veno-occlusive disease and acute graft-versus-host disease, at the time when immunosuppressants were withdrawn, the patient experienced recurrent fever accompanied by elevated inflammatory indicators. After receiving glucocorticoids and ibuprofen, the patient’s condition improved, and a diagnosis with BCG-related IRIS was made.
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Nichols-Vinueza DX, Parta M, Shah NN, Cuellar-Rodriguez JM, Bauer TR, West RR, Hsu AP, Calvo KR, Steinberg SM, Notarangelo LD, Holland SM, Hickstein DD. Donor source and post-transplantation cyclophosphamide influence outcome in allogeneic stem cell transplantation for GATA2 deficiency. Br J Haematol 2022; 196:169-178. [PMID: 34580862 PMCID: PMC8702451 DOI: 10.1111/bjh.17840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023]
Abstract
GATA2 deficiency was described in 2011, and shortly thereafter allogeneic hematopoietic stem cell transplantation (HSCT) was shown to reverse the hematologic disease phenotype. However, there remain major unanswered questions regarding the type of conditioning regimen, type of donors, and graft-versus-host disease (GVHD) prophylaxis. We report 59 patients with GATA2 mutations undergoing HSCT at National Institutes of Health between 2013 and 2020. Primary endpoints were engraftment, reverse of the clinical phenotype, secondary endpoints were overall survival (OS), event-free survival (EFS), and the incidence of acute and chronic GVHD. The OS and EFS at 4 years were 85·1% and 82·1% respectively. Ninety-six percent of surviving patients had reversal of the hematologic disease phenotype by one-year post-transplant. Incidence of grade III-IV aGVHD in matched related donor (MRD) and matched unrelated donor recipients (URD) patients receiving Tacrolimus/Methotrexate for GVHD prophylaxis was 32%. In contrast, in the MRD and URD who received post-transplant cyclophosphamide (PT/Cy), no patient developed grade III-IV aGVHD. Six percent of haploidentical related donor (HRD) recipients developed grade III-IV aGVHD. In summary, a busulfan-based HSCT regimen in GATA2 deficiency reverses the hematologic disease phenotype, and the use of PT/Cy reduced the risk of both aGVHD and cGVHD.
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Affiliation(s)
- Diana X. Nichols-Vinueza
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD
| | - Mark Parta
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Nirali N. Shah
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD
| | - Jennifer M. Cuellar-Rodriguez
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD
| | - Thomas R. Bauer
- Immune Deficiency – Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Robert R. West
- Immune Deficiency – Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Amy P. Hsu
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD
| | | | - Seth M. Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Luigi D. Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, MD
| | - Dennis D. Hickstein
- Immune Deficiency – Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Manion M, Dimitrova D, Pei L, Gea-Banacloche J, Zelazny A, Lisco A, Zerbe C, Freeman AF, Holland SM, Kanakry CG, Kanakry JA, Sereti I. Immune Reconstitution Inflammatory Syndrome as a Posttransplantation Complication in Primary Immunodeficiency With Disseminated Mycobacterium avium. Clin Infect Dis 2021; 70:676-679. [PMID: 31190050 DOI: 10.1093/cid/ciz507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/11/2019] [Indexed: 01/22/2023] Open
Abstract
Patients with primary immunodeficiencies undergoing allogeneic hematopoietic cell transplantation (HCT) for difficult-to-control infections can experience immune reconstitution inflammatory syndrome (IRIS) following engraftment. In 3 patients with post-HCT IRIS related to mycobacterial infection, in vitro data demonstrate the emergence of pathogen-specific immune responses and a concomitant rise in plasma inflammatory markers.
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Affiliation(s)
- Maura Manion
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Dimana Dimitrova
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Luxin Pei
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Adrian Zelazny
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland
| | - Andrea Lisco
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Christa Zerbe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Alexandra F Freeman
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Steven M Holland
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Jennifer A Kanakry
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Irini Sereti
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Campagna A, Gianfelici V, Antolino G, Pelliccia S, Galassi G, Piedimonte M, Bianchi MP, Mirabilii S, Ricciardi MR, Tasca G, Iorio R, Conte E, Ferrari A, La Verde G, Tafuri A. Central nervous system immune reconstitution inflammatory syndrome after autologous stem cell transplantation. Bone Marrow Transplant 2019; 55:268-271. [PMID: 31068657 DOI: 10.1038/s41409-019-0532-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Alessia Campagna
- Hematology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Valentina Gianfelici
- Laboratory of Cell Kinetics and Applied Proteomics, Faculty of Medicine and Psychology, Department of Clinic and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giusy Antolino
- Hematology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Sabrina Pelliccia
- Hematology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Giulia Galassi
- Hematology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Monica Piedimonte
- Laboratory of Cell Kinetics and Applied Proteomics, Faculty of Medicine and Psychology, Department of Clinic and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Paola Bianchi
- Laboratory of Cell Kinetics and Applied Proteomics, Faculty of Medicine and Psychology, Department of Clinic and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Simone Mirabilii
- Laboratory of Cell Kinetics and Applied Proteomics, Faculty of Medicine and Psychology, Department of Clinic and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Rosaria Ricciardi
- Laboratory of Cell Kinetics and Applied Proteomics, Faculty of Medicine and Psychology, Department of Clinic and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Tasca
- Neurology, Department of Aging, Neurological and Head-Neck Sciences, A. Gemelli University Hospital, IRCCS, Rome, Italy
| | - Raffaele Iorio
- Neurology, Department of Aging, Neurological and Head-Neck Sciences, A. Gemelli University Hospital, IRCCS, Rome, Italy
| | - Esmeralda Conte
- Hematology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonella Ferrari
- Hematology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Giacinto La Verde
- Hematology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Agostino Tafuri
- Hematology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy. .,Laboratory of Cell Kinetics and Applied Proteomics, Faculty of Medicine and Psychology, Department of Clinic and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
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Simonis A, Fux M, Nair G, Mueller NJ, Haralambieva E, Pabst T, Pachlopnik Schmid J, Schmidt A, Schanz U, Manz MG, Müller AMS. Allogeneic hematopoietic cell transplantation in patients with GATA2 deficiency-a case report and comprehensive review of the literature. Ann Hematol 2018; 97:1961-1973. [PMID: 29947977 DOI: 10.1007/s00277-018-3388-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/27/2018] [Indexed: 01/12/2023]
Abstract
Recently, an immunodeficiency syndrome caused by guanine-adenine-thymine-adenine 2 (GATA2) deficiency has been described. The syndrome is characterized by (i) typical onset in early adulthood, (ii) profound peripheral blood cytopenias of monocytes, B lymphocytes, and NK cells, (iii) distinct susceptibility to disseminated non-tuberculous mycobacterial (NTM) and other opportunistic infections (particularly human papillomavirus), and (iv) a high risk of developing hematologic malignancies (myelodysplastic syndromes (MDS); acute myeloid leukemias (AML)). Considerable clinical heterogeneity exists among patients with GATA2 deficiency, but once infectious symptoms occur or MDS/AML arises, survival declines significantly. Allogeneic hematopoietic cell transplantation (HCT) currently provides the only curative treatment option for both MDS/AML and dysfunctional immunity with life-threatening opportunistic infections. Strategies regarding timing of allogeneic HCT, antimicrobial prophylaxis and treatment, intensity of the preparative regimen, and optimal donor and graft source have not been clearly defined due to the rarity of the disease. Here, we provide a comprehensive analysis of the available literature and published case reports on the use of allogeneic HCT in patients with GATA2 deficiency. In addition, a case of a young woman with GATA2 deficiency, who developed an immune reconstitution inflammatory syndrome in her mycobacterial skin lesions post allogeneic HCT is presented and illustrates distinct problems encountered in this disease context.
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Affiliation(s)
- Alexander Simonis
- Division of Hematology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Michaela Fux
- Center of Laboratory Medicine, University Hospital, Inselspital Bern, CH-3010, Bern, Switzerland
| | - Gayathri Nair
- Division of Hematology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Eugenia Haralambieva
- Department of Pathology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, University Hospital, Inselspital Bern, CH-3010, Bern, Switzerland
| | - Jana Pachlopnik Schmid
- Pediatric Immunology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | - Adrian Schmidt
- Department of Internal Medicine, Division of Medical Oncology and Hematology, City Hospital Triemli, Birmensdorferstrasse 497, CH-8063, Zurich, Switzerland
| | - Urs Schanz
- Division of Hematology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Markus G Manz
- Division of Hematology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Antonia M S Müller
- Division of Hematology, University and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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