Phase I dose escalation study of naive T-cell depleted donor lymphocyte infusion following allogeneic stem cell transplantation

Abstract

Prophylactic donor lymphocyte infusions (DLI) are used to augment post-transplant immune recovery to reduce both infectious complications and disease recurrence. Preclinical studies implicate the naive T-cell subset as the primary driver of graft-versus-host disease (GvHD). In this phase I dose escalation study, we assessed the safety of a DLI that was depleted of CD45RA+ naive T cells. Sixteen adult patients received a prophylactic DLI at a median of 113 days (range 76–280 days) following an HLA-identical, non-myeloablative allogeneic hematopoietic stem cell transplantation. Three patients each received the naive T-cell depleted DLI with a CD3+ dose of 1 × 105/kg, 1 × 106/kg, and 5 × 106/kg. The maximum dose of 1 × 107/kg was expanded to 7 patients. No dose-limiting grade III/IV acute GvHD or adverse events attributable to the DLI were observed at any dose level. One patient developed grade 2 acute GvHD of skin and upper intestines, and another developed moderate chronic GvHD of the lungs following the DLI. With a median follow-up of 2.8 years, 2-year progression-free and overall survival is 50.0% and 68.8%, respectively. In conclusion, these data suggest that a DLI that has been depleted of CD45RA+ naive T cells is feasible and carries a low risk of acute or chronic GvHD.

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Fig. 1: Protocol Schema.
Fig. 2
Fig. 3: Progression-free and overall survival for patients receiving a naïve T-cell depleted donor lymphocyte infusions.
Fig. 4: Acute and Chronic Graft versus Host Disease (GvHD) attributable to the naïve T-cell depleted DLI.
Fig. 5: Immune reconstitution following the naïve T-cell depleted DLI.

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Acknowledgements

Ko Maung is supported by NIH T32HL007057 grant.

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Correspondence to Mitchell E. Horwitz.

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Maung, K.K., Chen, B.J., Barak, I. et al. Phase I dose escalation study of naive T-cell depleted donor lymphocyte infusion following allogeneic stem cell transplantation. Bone Marrow Transplant (2020). https://doi.org/10.1038/s41409-020-0991-5

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