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Lisco A, Hsu AP, Dimitrova D, Proctor DM, Mace EM, Ye P, Anderson MV, Hicks SN, Grivas C, Hammoud DA, Manion M, Starrett GJ, Farrel A, Dobbs K, Brownell I, Buck C, Notarangelo LD, Orange JS, Leonard WJ, Orestes MI, Peters AT, Kanakry JA, Segre JA, Kong HH, Sereti I. Treatment of Relapsing HPV Diseases by Restored Function of Natural Killer Cells. N Engl J Med 2021; 385:921-929. [PMID: 34469647 PMCID: PMC8590529 DOI: 10.1056/nejmoa2102715] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Human papillomavirus (HPV) infections underlie a wide spectrum of both benign and malignant epithelial diseases. In this report, we describe the case of a young man who had encephalitis caused by herpes simplex virus during adolescence and currently presented with multiple recurrent skin and mucosal lesions caused by HPV. The patient was found to have a pathogenic germline mutation in the X-linked interleukin-2 receptor subunit gamma gene (IL2RG), which was somatically reverted in T cells but not in natural killer (NK) cells. Allogeneic hematopoietic-cell transplantation led to restoration of NK cytotoxicity, with normalization of the skin microbiome and persistent remission of all HPV-related diseases. NK cytotoxicity appears to play a role in containing HPV colonization and the ensuing HPV-related hyperplastic or dysplastic lesions. (Funded by the National Institutes of Health and the Herbert Irving Comprehensive Cancer Center Flow Cytometry Shared Resources.).
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Affiliation(s)
- Andrea Lisco
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Amy P Hsu
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Dimana Dimitrova
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Diana M Proctor
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Emily M Mace
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Peiying Ye
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Megan V Anderson
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Stephanie N Hicks
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Christopher Grivas
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Dima A Hammoud
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Maura Manion
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Gabriel J Starrett
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Alvin Farrel
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Kerry Dobbs
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Isaac Brownell
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Christopher Buck
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Luigi D Notarangelo
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Jordan S Orange
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Warren J Leonard
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Michael I Orestes
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Anju T Peters
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Jennifer A Kanakry
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Julia A Segre
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Heidi H Kong
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
| | - Irini Sereti
- From the Laboratories of Immunoregulation (A.L., P.Y., M.V.A., C.G., M.M., I.S.) and Clinical Immunology and Microbiology (A.P.H., K.D., L.D.N.), National Institute of Allergy and Infectious Diseases, the Experimental Transplantation and Immunotherapy Branch (D.D., S.N.H., J.A.K.) and the Laboratory of Cellular Oncology (G.J.S., C.B.), National Cancer Institute, the Translational and Functional Genomics Branch, National Human Genome Research Institute (D.M.P., J.A.S.), the Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung, and Blood Institute (A.F., W.J.L.), the Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (H.H.K., I.B.), and the Center for Infectious Disease Imaging (D.A.H.), National Institutes of Health, and Walter Reed National Military Medical Center (M.I.O.) - all in Bethesda, MD; Vagelos College of Physicians and Surgeons, Columbia University, New York (E.M.M., J.S.O.); and the Department of Medicine and Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago (A.T.P.)
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8
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Dimitrova D, Gea-Banacloche J, Steinberg SM, Sadler JL, Hicks SN, Carroll E, Wilder JS, Parta M, Skeffington L, Hughes TE, Blau JE, Broadney MM, Rose JJ, Hsu AP, Fletcher R, Nunes NS, Yan XY, Telford WG, Kapoor V, Cohen JI, Freeman AF, Garabedian E, Holland SM, Lisco A, Malech HL, Notarangelo LD, Sereti I, Shah NN, Uzel G, Zerbe CS, Fowler DH, Gress RE, Kanakry CG, Kanakry JA. Prospective Study of a Novel, Radiation-Free, Reduced-Intensity Bone Marrow Transplantation Platform for Primary Immunodeficiency Diseases. Biol Blood Marrow Transplant 2020; 26:94-106. [PMID: 31493539 PMCID: PMC6942248 DOI: 10.1016/j.bbmt.2019.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 12/20/2022]
Abstract
Allogeneic blood or marrow transplantation (BMT) is a potentially curative therapy for patients with primary immunodeficiency (PID). Safe and effective reduced-intensity conditioning (RIC) approaches that are associated with low toxicity, use alternative donors, and afford good immune reconstitution are needed to advance the field. Twenty PID patients, ranging in age from 4 to 58 years, were treated on a prospective clinical trial of a novel, radiation-free and serotherapy-free RIC, T-cell-replete BMT approach using pentostatin, low-dose cyclophosphamide, and busulfan for conditioning with post-transplantation cyclophosphamide-based graft-versus-host-disease (GVHD) prophylaxis. This was a high-risk cohort with a median hematopoietic cell transplantation comorbidity index of 3. With median follow-up of survivors of 1.9 years, 1-year overall survival was 90% and grade III to IV acute GVHD-free, graft-failure-free survival was 80% at day +180. Graft failure incidence was 10%. Split chimerism was frequently observed at early post-BMT timepoints, with a lower percentage of donor T cells, which gradually increased by day +60. The cumulative incidences of grade II to IV and grade III to IV acute GVHD (aGVHD) were 15% and 5%, respectively. All aGVHD was steroid responsive. No patients developed chronic GVHD. Few significant organ toxicities were observed. Evidence of phenotype reversal was observed for all engrafted patients, even those with significantly mixed chimerism (n = 2) or with unknown underlying genetic defect (n = 3). All 6 patients with pre-BMT malignancies or lymphoproliferative disorders remain in remission. Most patients have discontinued immunoglobulin replacement. All survivors are off immunosuppression for GVHD prophylaxis or treatment. This novel RIC BMT approach for patients with PID has yielded promising results, even for high-risk patients.
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Affiliation(s)
- Dimana Dimitrova
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Seth M Steinberg
- Biostatistics and Data Management Section, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Jennifer L Sadler
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stephanie N Hicks
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ellen Carroll
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jennifer S Wilder
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland
| | - Mark Parta
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland
| | - Lauren Skeffington
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Thomas E Hughes
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Jenny E Blau
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Miranda M Broadney
- Section on Growth and Obesity, Program in Endocrinology, Metabolism and Genetics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jeremy J Rose
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy P Hsu
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
| | - Rochelle Fletcher
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Natalia S Nunes
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Xiao-Yi Yan
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William G Telford
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Veena Kapoor
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey I Cohen
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Alexandra F Freeman
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth Garabedian
- Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven M Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
| | - Andrea Lisco
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Harry L Malech
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Nirali N Shah
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
| | - Christa S Zerbe
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
| | - Daniel H Fowler
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ronald E Gress
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Christopher G Kanakry
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jennifer A Kanakry
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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