Abstract
Allogenic stem cell transplantation (allo-SCT) represents the only curative option for several hematological malignancies. Due to a delayed and dysfunctional immunological recovery infectious complications and residual tumor cells following allo-SCT are still major causes of failure of this procedure. Here we discuss the most common infectious complications of allo-SCT and describe current and future strategies to prophylaxe or treat these complications using novel immunotherapeutic strategies.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Seggewiss R, Einsele H . Immune reconstitution after allogeneic transplantation and expanding options for immunomodulation: an update. Blood 2010; 115: 3861–3868.
Einsele H, Hebart H, Kauffmann-Schneider C, Sinzger C, Jahn G, Bader P et al. Risk factors for treatment failures in patients receiving PCR-based preemptive therapy for CMV infection. Bone Marrow Transplant 2000; 25: 757–763.
Marty FM, Winston DJ, Rowley SD, Vance E, Papanicolaou GA, Mullane KM et al. CMX001-201 Clinical Study Group. CMX001 to prevent cytomegalovirus disease in hematopoietic-cell transplantation. N Engl J Med 2013; 369: 1227–1236.
Rasche L, Kapp M, Einsele H, Mielke S . EBV-induced post transplant lymphoproliferative disorders: a persisting challenge in allogeneic hematopoetic SCT. Bone Marrow Transplant 2014; 49: 163–167.
Marty FM, Ljungman P, Papanicolaou GA, Winston DJ, Chemaly RF, Strasfeld L et al. Maribavir prophylaxis for prevention of cytomegalovirus disease in recipients of allogeneic stem-cell transplants: a phase 3, double-blind, placebo-controlled, randomised trial. Lancet. 2011 Infect Dis 11: 284–292.
Feuchtinger T, Lücke J, Hamprecht K, Richard C, Handgretinger R, Schumm M et al. Detection of adenovirus-specific T cells in children with adenovirus infection after allogeneic stem cell transplantation. Br J Haematol 2005; 128: 503–509.
Gerdemann U, Vera JF, Rooney CM, Leen AM . Generation of multivirus-specific T cells to prevent/treat viral infections after allogeneic hematopoietic stem cell transplant. J Vis Exp 2011; 51: 2736–2742.
Zandvliet ML, van Liempt E, Jedema I, Kruithof S, Kester MG, Guchelaar HJ et al. Simultaneous isolation of CD8(+) and CD4(+) T cells specific for multiple viruses for broad antiviral immune reconstitution after allogeneic stem cell transplantation. J Immunother 2011; 34: 307–319.
Stühler C, Khanna N, Bozza S, Zelante T, Moretti S, Kruhm M et al. Cross-protective TH1 immunity against Aspergillus fumigatus and Candida albicans. Blood 2011; 117: 5881–5891.
Khanna N, Stühler C, Conrad B, Lurati S, Krappmann S, Einsele H et al. Generation of a multiple pathogen-specific T-cell product for adoptive immunotherapy based on activation-dependent expression of CD154. Blood 2011; 118: 1121–1131.
Hebart H, Bollinger C, Fisch P, Sarfati J, Meisner C, Baur M et al. Analysis of T-cell responses to Aspergillus fumigatus antigens in healthy individuals and patients with hematologic malignancies. Blood 2002; 100: 4521–4528.
Perruccio K, Tosti A, Burchielli E, Topini F, Ruggeri L, Carotti A et al. Transferring functional immune responses to pathogens after haploidentical hematopoietic transplantation. Blood 2005; 106: 4397–4406.
Bouzani M, Ok M, McCormick A, Ebel F, Kurzai O, Morton CO et al. Human NK cells display important antifungal activity against Aspergillus fumigatus, which is directly mediated by IFN-γ release. J Immunol. 2011; 187: 1369–1376.
Bouzani M, Einsele H, Loeffler J . Functional analysis is a paramount prerequisite for understanding the in vitro interaction of human natural killer cells with Aspergillus fumigatus. J Infect Dis 2012; 205: 1025–1026.
Lehrnbecher T, Tramsen L, Koehl U, Schmidt S, Bochennek K, Klingebiel T . Immunotherapy against invasive fungal diseases in stem cell transplant recipients. Immunol Invest 2011; 40: 839–852.
Smetak M, Kimmel B, Birkmann J, Schaefer-Eckart K, Einsele H, Wilhelm M et al. Clinical-scale single-step CD4(+) and CD8(+) cell depletion for donor innate lymphocyte infusion (DILI). Bone Marrow Transplant 2008; 41: 643–650.
Wilhelm M, Smetak M, Schaefer-Eckart K, Kimmel B, Birkmann J, Einsele H et al. Successful adoptive transfer and in vivo expansion of haploidentical γδ T cells. J Transl Med 2014; 12: 45.
Kunzmann V, Kimmel B, Herrmann T, Einsele H, Wilhelm M . Inhibition of phosphoantigen-mediated gammadelta T-cell proliferation by CD4+ CD25+ FoxP3+ regulatory T cells. Immunology 2009; 126: 256–267.
Kunzmann V, Bauer E, Wilhelm M . Gamma/delta T-cell stimulation by pamidronate. N Engl J Med. 1999; 340: 737–738.
Kunzmann V, Bauer E, Feurle J, Weissinger F, Tony HP, Wilhelm M . Stimulation of gammadelta T cells by aminobisphosphonates and induction of antiplasma cell activity in multiple myeloma. Blood 2000; 96: 384–392.
Einsele H, Roosnek E, Rufer N, Sinzger C, Riegler S, Löffler J et al. Infusion of cytomegalovirus (CMV)-specific T cells for the treatment of CMV infection not responding to antiviral chemotherapy. Blood 2002; 99: 3916–3922.
Feuchtinger T, Matthes-Martin S, Richard C, Lion T, Fuhrer M, Hamprecht K et al. Safe adoptive transfer of virus-specific T-cell immunity for the treatment of systemic adenovirus infection after allogeneic stem cell transplantation. Br J Haematol 2006; 134: 64–76.
Leen AM, Myers GD, Sili U, Huls MH, Weiss H, Leung KS et al. Monoculture-derived T lymphocytes specific for multiple viruses expand and produce clinically relevant effects in immunocompromised individuals. Nat Med 2006; 12: 1160–1166.
Icheva V, Kayser S, Wolff D, Tuve S, Kyzirakos C, Bethge W et al. Adoptive transfer of EBNA1-specific T cells as a treatment of Epstein-Barr-Virus reactivation and lymphoproliferative disorders following allogeneic stem cell transplantation. J Clin Oncol 2013; 31: 39–48.
Gattinoni L, Lugli E, Ji Y, Pos Z, Paulos CM, Quigley MF et al. A human memory T cell subset with stem cell-like properties. Nat Med 2011; 17: 1290–1297.
Stemberger C, Huster KM, Koffler M, Anderl F, Schiemann M, Wagner H et al. A single naive CD8+ T cell precursor can develop into diverse effector and memory subsets. Immunity 2007; 27: 985–997.
Buchholz VR, Flossdorf M, Hensel I, Kretschmer L, Weissbrich B, Graf P et al. Disparate individual fates compose robust CD8+ T cell immunity. Science 2013; 340: 630–635.
Riddell SR, Watanabe KS, Goodrich JM, Li CR, Agha ME, Greenberg PD . Restoration of viral immunity in immunodeficient humans by the adoptive transfer of T cell clones. Science 1991; 257: 238–241.
Schmitt A, Tonn T, Busch DH, Grigoleit GU, Einsele H, Odendahl M et al. Adoptive transfer and selective reconstitution of streptamer-selected cytomegalovirus-specific CD8+ T cells leads to virus clearance in patients after allogeneic peripheral blood stem cell transplantation. Transfusion 2011; 51: 591–599.
Rauser G, Einsele H, Sinzger C, Wernet D, Kuntz G, Assenmacher M et al. Rapid generation of combined CMV-specific CD4+ and CD8+ T-cell lines for adoptive transfer into recipients of allogeneic stem cell transplants. Blood 2004; 103: 3565–3572.
Feuchtinger T, Opherk K, Bethge WA, Topp MS, Schuster FR, Weissinger EM et al. Adoptive transfer of pp-65 specific T-cells for the treatment of chemorefractory cytomegalovirus disease or reactivation after haploidentical and matched unrelated stem cell transplantation. Blood 2010; 116: 4360–4367.
Mielke S, McIver ZA, Shenoy A, Fellowes V, Khuu H, Stroncek DF et al. Selectively T cell-depleted allografts from HLA-matched sibling donors followed by low-dose posttransplantation immunosuppression to improve transplantation outcome in patients with hematologic malignancies. Biol Blood Marrow Transplant 2011; 17: 1855–1861.
Stühler C, Mielke S, Chatterjee M, Duell J, Lurati S, Rueckert F et al. Selective depletion of alloreactive T cells by targeted therapy of heat shock protein 90: a novel strategy for control of graft-versus-host disease. Blood 2009; 114: 2829–2836.
Mielke S, Nunes R, Rezvani K, Fellowes VS, Venne A, Solomon SR et al. A clinical-scale selective allodepletion approach for the treatment of HLA-mismatched and matched donor-recipient pairs using expanded T lymphocytes as antigen-presenting cells and a TH9402-based photodepletion technique. Blood 2008; 111: 4392–4402.
Mielke S, Rezvani K, Savani BN, Nunes R, Yong AS, Schindler J et al. Reconstitution of FOXP3+ regulatory T cells (Tregs) after CD25-depleted allotransplantation in elderly patients and association with acute graft-versus-host disease. Blood 2007; 110: 1689–1697.
Mielke S, Solomon SR, Barrett AJ . Selective depletion strategies in allogeneic stem cell transplantation. Cytotherapy 2005; 7: 109–115 Review.
Feuchtinger T, Richard C, Joachim S, Scheible MH, Schumm M, Hamprecht K et al. Clinical grade generation of hexon-specific T cells for adoptive T-cell Transfer as a treatment of adenovirus infection after allogeneic stem cell transplantation. J Immunother 2008; 31: 199–206.
Schottker B, Feuchtinger T, Schumm M, Klinker E, Handgretinger R, Einsele H et al. Five donors-one recipient: modeling a mosaic of granulocytes, natural killer and T cells from cord-blood and third-party donors. Nat Clin Pract Oncol 2008; 5: 291–295.
Leen AM, Bollard CM, Mendizabal AM, Shpall EJ, Szabolcs P, Antin JH et al. Multicenter study of banked third-party virus-specific T cells to treat severe viral infections after hematopoietic stem cell transplantation. Blood 2013; 121: 5113–5123.
Walter EA, Greenberg PD, Gilbert MJ, Finch RJ, Watanabe KS, Thomas ED et al. Reconstitution of cellular immunity against cytomegalovirus in recipients of allogeneic bone marrow by transfer of T-cell clones from the donor. N Engl J Med. 1995; 333: 1038–1044.
Louis CU, Savoldo B, Dotti G, Pule M, Yvon E, Myers GD et al. Antitumor activity and long-term fate of chimeric antigen receptor-positive T cells in patients with neuroblastoma. Blood 2011; 118: 6050–6056.
Gerdemann U, Keirnan JM, Katari UL, Yanagisawa R, Christin AS, Huye LE et al. Rapidly generated multivirus-specific cytotoxic T lymphocytes for the prophylaxis and treatment of viral infections. Mol Ther 2012; 20: 1622–1632.
Stemberger C, Graef P, Odendahl M, Albrecht J, Dössinger G, Anderl F et al. Lowest numbers of primary CD8+ T cells can reconstitute protective immunity upon adoptive immunotherapy. Blood 2014; 124: 628–637.
Jedema I, van de Meent M, Pots J, Kester MG, van der Beek MT, Falkenburg JH . Successful generation of primary virus-specific and anti-tumor T-cell responses from the naive donor T-cell repertoire is determined by the balance between antigen-specific precursor T cells and regulatory T cells. Haematologica 2011; 96: 1204–1212.
Acknowledgements
Research Funds were received for this project by EU FP7 T-Control and the Deutsche Forschungsgemeinschaft (DFG) CRC/TR 124.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
HE received consulting and lecture fees from Celgene, Janssen, Amgen, Onyx and Novartis. JL received grant support from Pfizer Europe. SM has received lecture fees from Deutschen Rentenversicherung, Cellex GmbH, Novartis Pharma, Shire, and grant support from Wilhelm-Sander-Stiftunq. Germany, Carreras-Leukamie-Stiftunq. The remaining authors declare no conflict of interest.
Additional information
This article was published as part of a supplement, supported by WIS-CSP Foundation, in collaboration with Gilead, Milteny Biotec, Gamida cell, Adienne Pharma and Biotech, Medac hematology, Kiadis Pharma, Almog Diagnostic.
Rights and permissions
About this article
Cite this article
Einsele, H., Löffler, J., Kapp, M. et al. Immunotherapy for viral and fungal infections. Bone Marrow Transplant 50 (Suppl 2), S51–S54 (2015). https://doi.org/10.1038/bmt.2015.96
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2015.96