Adoptive transfer of pp65-specific T cells for the treatment of chemorefractory cytomegalovirus disease or reactivation after haploidentical and matched unrelated stem …

T Feuchtinger, K Opherk, WA Bethge… - Blood, The Journal …, 2010 - ashpublications.org
T Feuchtinger, K Opherk, WA Bethge, MS Topp, FR Schuster, EM Weissinger, M Mohty, R Or…
Blood, The Journal of the American Society of Hematology, 2010ashpublications.org
Cytomegalovirus (CMV) disease and infection refractory to antiviral treatment after
allogeneic stem cell transplantation (allo-SCT) is associated with a high mortality. Adoptive
transfer of CMV-specific T cells could reconstitute viral im-munity after SCT and could protect
from CMV-related complications. However, logistics of producing virus-specific T-cell grafts
limited the clinical application. We treated 18 patients after allo-SCT from human leukocyte
antigen–mismatched/haploidentical or human leukocyte antigen–matched unrelated donors …
Abstract
Cytomegalovirus (CMV) disease and infection refractory to antiviral treatment after allogeneic stem cell transplantation (allo-SCT) is associated with a high mortality. Adoptive transfer of CMV-specific T cells could reconstitute viral im-munity after SCT and could protect from CMV-related complications. However, logistics of producing virus-specific T-cell grafts limited the clinical application. We treated 18 patients after allo-SCT from human leukocyte antigen–mismatched/haploidentical or human leukocyte antigen–matched unrelated donors with polyclonal CMV-specific T cells generated by ex vivo stimulation with pp65, followed by isolation of interferon-γ–producing cells. Patients with CMV disease or viremia refractory to antiviral chemotherapy or both were eligible for adoptive T-cell transfer and received a mean of 21 × 103/kg pp65-specific T cells. In 83% of cases CMV infection was cleared or viral burden was significantly reduced, even in cases of CMV encephalitis (n = 2). Viral control was associated with in vivo expansion of CMV-specific T lymphocytes in 12 of 16 evaluable cases, resulting in reconstitution of antiviral T-cell responses, without graft-versus-host disease induction or acute side effects. Our findings indicate that the infusion of low numbers of CMV-specific T cells is safe, feasible, and effective as a treatment on demand for refractory CMV infection and CMV disease after allo-SCT.
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