Introduction
Definition
Myeloablative Conditioning Regimens in PID
Author, Year | Year of HCT | No. of patients/diagnosis | Median age at HCT (range), years | Donor and stem cell source | Conditioning regimen | OS |
---|---|---|---|---|---|---|
Fisher, 1994 [6] | 1977–1991 | 149 non-SCID PID received 171 transplants | Range 0.1–16 | 65 MSD/MFD 6 MUD 78 MMUD | Bu+Cy 12 additional TBI | Before 1985, 51.7% After 1985, 81.5% |
Klein, 1995 [7] | 1981–1993 | 19 MHC class II deficiency (7 s HCT) | 1.4 (0.5–9.5) | 8 MFD marrow 1 MMFD marrow 10 HID marrow All 7 s HCT used HID | MFD Bu20mg/kg + Cy 200 mg/kg or Cy 50 mg/kg + ALG or Cy 50 mg/kg + CCNU 300 mg/m2 + procarbazine 280 mg/kg + ALG MMFD Bu 16 mg/kg + Cy 200 mg/kg or Bu 20 mg/kg + Cy 200 mg/kg + anti-LFA-1 antibody or Bu 20 mg/kg + Cy 200 mg/kg + anti-LFA-1 antibody + anti-CD2 antibody | 47% |
Antoine, 2003 [8] | 1968–1999 | 1082 HCT in 919 PID patients 566 HCT in 475 SCID patients 512 HCT in 444 non-SCID PID patients | SCID: 5.5 months Non-SCID: 34.6 months | 88% marrow 12% PBSC 0.7% CB T cell depletion: 91% MD 41% UD marrow | 205 SCID: unconditioned 361 SCID: Bu 8 mg/kg + Cy 200 mg/kg 512 non-SCID; Bu 16 mg/kg + cy 200 mg/kg | SCID: 77% MD vs 54% in MMD Non-SCID: 71% MFD vs 42% MUD vs 59% MMD |
Renella, 2006 [9] | 1981–2004 | 15 MHC class II deficiency | 1.5 (0.3–5.4) | 13 MFD marrow 2 MUD marrow | Bu 16-20 mg/kg + Cy 200 mg/kg + ATG in MUD | 53% |
RTC Regimens in PID
Author, year | Year of HCT | No of patients/diagnosis | Median age at HCT (range), years | Donor and stem cell source | Conditioning regimen and GvHD prophylaxis | Median day of N engraftment | VOD, n | aGvHD % | cGvHD % | OS % | ES % | Graft failure % | Second procedure, n | Latest donor chimerism/remarks |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Fludarabine and treosulfan | ||||||||||||||
Slatter, 2018 [11] | 2006–2013 | 160 39 SCID 20 WAS 17 CGD 18 HLH 66 Other PID: | 1.36 (0.1–18.3) | 29 MSD/MFD 73 MUD 54MMUD 4 HID 49 marrow 70 PBSC 41 CB | Flu 150 mg/m2 + Treo 42 g/m2 (36g/m2 if < 1 year; 30 g/m2 for SCID) + alemtuzumab 0.3 to 1.0 mg/kg GvHD prophylaxis: CSA/MMF | NA | 0 | I–IV: 46 III–IV: 9 | 15 | 2-year OS: 88 5-year OS: 78 | 2-year ES: 88 5-year ES: 78 | 3 | 4 s HCT for graft loss or poor immune reconstitution 5 unconditioned boost 3 DLI | PBSC was associated with better donor myeloid chimerism without an increased risk of GvHD |
Morillo-Gutierrez, 2016 [12] | 2006–2015 | 70 CGD | 8.9 (IQR 3.8–19.3) | 13 MSD/MFD 44MUD 12 MMUD 1 HID 36 marrow 32 PBSC 1 TCR ∝β/CD19 depleted PBSC 1 CB | 46 Flu150mg/m2 + Treo 42 g/m2 (36g/m2 if < 1 year) Alemtuzumab (n = 39) or ATG (n = 18) or no serotherapy (n = 13) 15 Flu + Treo + TT + alemtuzumab or ATG 9 other Treo-based conditioning regimen GvHD prophylaxis: CSA ± MMF or MTX | 17 (IQR 15–35) | 0 | I–II: 39 III–IV: 12 | 13 | 91.4 | 81.4 | 12 | 8 (2 unconditioned boost; 3 DLI; 5 conditioned 2nd HCT [2 had DLI]) | Myeloid ≥ 95%: 80% surviving patients |
Slatter, 2015 [13] | 2005–2010 | 316 144 PID 39 IMD 70 H-globinopathy 32 histiocytic disorders 24 marrow failure 2 autoimmune disease 5 others | < 1 year, n = 95 1–12 years, n = 189 > 12 years, n = 32 | 94 MSD/MFD 29 MMRD 39 MUD 16 MMUD 138 undefined UD 167 marrow 8 marrow + CB 3 marrow + PBSC 87 PBSC 1 PBSC + CB 50 CB | 106 Flu 150 mg/m2 + Treo 42 g/m2 98 Cy 200 mg/kg + Treo 42 g/m2 104 Flu 150 mg/m2 + Treo 42 g/m2 + TT 8 mg/kg 8 Flu 150 mg/m2 + Treo 42 g/m2 + melphalan GvHD prophylaxis: 284 CSA alone 100 CSA + MMF 101 CSA + MTX | NA | 0 | I–IV: 38 III–IV: 10 | NA | 83 | 76 | 5.1 | NA | NA |
Burroughs, 2014 [14] | 2009–2013 | 31 6 IPEX 5 CGD 2 other PID 6 HLH 6 BM failures 6 RBC disorders | 10.7 (0.4–30.5) | 4 MSD 27 MUD 29 marrow 2 PBSC | Flu 150 mg/m2 + Treo 42 g/m2 Serotherapy: 22 ATG GvHD prophylaxis: Tacrolimus + MTX | 21 (range, 12–46) | 0 | II–IV: 62 III–IV: 10 | 21 | 90 | NA | 3 | 2 s HCT | ATG patients: 19 (86%) full or high level of mixed CD3 chimerism 3 (14%) low-level mixed donor CD3 chimerism No ATG patients: 6 full/high level of mixed CD3 chimerism 2 low-level mixed donor CD3 chimerism 1 graft failure |
Dinur-Schejter, 2015 [15] | 2009–2013 | 45 HCT in 44 patients 12 SCID 5 severe congenital neutropenia 2 WAS 2 CGD 1 HLH 10 PID 5 thalassaemia 5 osteopetrosis 3 IMD 4 others | 1.5 (0.1–15.1) | 19 MSD/MFD 3 MMFD 14 MUD 9 unrelated CB | 19 Flu + Treo 6 Cy + Treo 20 Flu + Treo + TT (Treo 36 g/m2 for < 1 year; 42 g/m2 for > 1 year) Serotherapy: 9 no serotherapy 26 ATG 8 Alemtuzumab 1 OKT3 | Flu/Treo/TT: 18.4 Flu/Treo: 25.3 Cy/Treo: 19.5 | 1 | I–IV: 44.4 III–IV: 27 | 18.9 | 71 | 55 | 14 | 3 s HCT (one had a further 3rd HCT) | Full: 31 (72%) Mixed: 6 (28%) |
Lehmberg, 2014 [16] | 2010–2012 | 19 HLH | 3.9 (0.2–22) | 1 MRD 6 MUD 9 MMUD HID 1 17 marrow 1 PBSC 1 CD34 selected PBSC for HID | 16 Flu150mg/m2 (3 Flu 160-180 mg/m2) + Treo 42 g/m2 (36g/m2 if < 12 kg) Alemtuzumab 0.3 mg—1.0 mg/kg 14 additional TT 10 mg/kg (7 mg/kg if < 12 kg) GvHD prophylaxis: 2 CSA alone 7 CSA + MMF 9 CSA + MTX 1 Tacrolimus + MMF | 20 (range 11–62) | 1 | I–II: 21 III–IV: 1 patient after DLI | No | 100 | NA | 11 (n = 2) | 2 s HCT (1 1° graft failure after HID; 1 2° graft failure) 6 DLI | WB > 95%: 10 WB 75–95%: 2 WB 20–74%: 4 |
Beier, 2013 [17] | 2003–2009 | 53 non-malignant patients 10 SCID 4 CGD 2 HLH 2 WAS 11 other PID 3 osteopetrosis 9 H-globinopathy 9 BM failure 1 IMD 2 0thers | 4.8 (0.1–20.1) | 16 MSD/MFD 1 MMFD 1 MUD 25 MUD I HID 2 CB + HID 36 marrow 11 PBSC 1 CB 2 CB + PBSC 2 NA | 15 Flu + Treo (1 additional radioimmunotherapy) 32 Flu + Treo + TT 5 Flu + Treo + melphalan Serotherapy 4 None 19 ATG 3 ATG + OKT3 1 ATG + alemtuzumab 16 alemtuzumab 1 alemtuzumab + rituximab 1 rituximab 5 OKT3 | 20 | 0 | I–IV: 32 III–IV: 4 | 6 (n = 3) | 87 | NA | 4 | NA | Full: 46 (87%) |
Slatter, 2011 [18] | 2006–2009 | 70 26 SCID 7 Omenn syndrome 7 WAS 4 HLH 4 LAD 4 CGD 2 IPX 16 other PID | 0.7 (0.1–14.6) | 21 MSD/MFD 45 MUS 4 HID | 40 Flu150mg/m2 + Treo 42 g/m2 30 Flu150mg/m2 + Cy 200 mg/kg 53 alemtuzumab 0.3 to 1.0 mg/kg | NA | 2 in Cy group | I–IV: 26 III–IV: 10 | 6 | 81 Flu: 85% Cy: 77% | NA | 3 (n = 2_ | 1 had both top-up and second conditioned HCT | 57% full donor chimerism 43% stable mixed chimerism |
Busulfan ± fludarabine | ||||||||||||||
Dvorak, 2019 [19] | 2011–2017 | 10 4 typical SCID 6 leaky SCID | 5 mos (range, 2–108 mos) | 2 MUD 2MMUD 6 HID Marrow for MUD/MMUD CD34 selected PBSC or HID | Bu with target AUC 30 mg*hr./L ATG or alemtuzumab For patients with any T cells: Additional Flu 160 mg/m2 For patients with NK cells: Additional TT 10 mg/kg 2 had plerixafor 9 h prior to each dose of Bu | 16 (range, 14–23) | 0 | II–IV: 2 patients | 0 | 100 | NA | 10 | 1 additional HCT | Median myeloid at one-year post HCT 14% (range, 2–100%) 6 had full T- and B cell reconstitution 3 had no B cell recovery (2 had rituximab for autoimmunity post-HCT) 3 had B cell autoimmunity |
Güngör, 2015 [20] | 2003–2015 | 56 CGD | 12.7 (IQR 6.8–17.3) | 21 MSD/MFD 25 MUD 10MMUD 45 marrow 11 PBSC | Flu 150 mg/m2 Bu with target AUC 45–65 mg*hr./Lxh Serotherapy ATG for MFD Alemtuzumab for MUD | 19 (IQR 16–22) | 0 | III–IV: 4 | 7 | 93 | 89 | 5 | 3 s HCT | Myeloid > 90%: 52 (93%) |
Jacobsohn, 2004 [21] | 2000–2004 | 13 6 PID 4 H-globionopathy 3 IMD | 5.2 (IQR, 0.6–11.1) | 4 MSD 1MMFD 6 MUD 2 unrelated CB 11 PBSC | Flu 150 mg/m2 Bu with target AUC 3800 to 4200umol x min ATG GvHD prophylaxis CSA ± MMF | 18 (IQR, 14–25) | 0 | II–IV: 8 | 25 | 84 | NA | 15 (2 h-globinopathy) | none | 72% full donor chimerism |
Fludarabine and melphalan | ||||||||||||||
Allen, 2018 [22] | 2013–2015 | 34 HLH 12 PID | 2.3 (0.4–28) | 7 MSD 1 MMRD 25 MUD 13 MMUD All had marrow | Flu 150 mg/m2 Melp 140 mg/m2 Alemtuzumab 1 mg/kg GvHD prophylaxis CSA and steroid | 13 | 0 | II–IV: 17.4 III–IV: 10.9 | 26.7 | 18-month OS: 66.9% | 60.9% with second procedure 39.1% without intervention | Primary: 4 Secondary: 4 | 2 s HCT | 57% had full chimerism in all cell lines 42% had stable mixed chimerism |
Fox, 2018 [23] | 2004–2014 | 29 PID | 11 MFD 13 MUD 5 MMUD | Non-CGD Flu 150 mg/m2 Melp 140 mg/m2 Alemtuzumab 100 mg CGD Flu 150 mg/m2 Meph 10 mg/m2 or Bu 9.6 mg/kg Alemtuzumab or ATG GvHD prophylaxis CSA | 13 (IQR, 11–17) | 0 | I–II: 45 III–IV: 3 | Limited: 34 Extensive: 1 | 1-yr: 85.2 | 1-year: 85.7 | None | None | 85% full chimerism | |
Marsh, 2010 [30] | 2003–2009 | 40 HLH | 1 (0.1–16) | 7 MFD 33 MUD 36 marrow 2 PBSC 2 CB | 26 RIC Flu 150 mg/m2 (5mg/kg if < 10 kg) Melp 140 mg/m2 (4.7 mg/kg if < 10 kg) Alemtuzumab 14 MAC Bu 14 mg/kg Cy 200 mg/kg 12 additional etoposide 30 mg/kg GvHD prophylaxis CSA or tacrolimus + steroid/MTX | MAC: 14.5 RIC: 10 | NA | II-III MAC: 14 RIC: 8 (p = 0.317) | MAC: 0 RIC: 12% limited | MAC: 43% RIC 89% (p = 0.0036) | NA | None | 3 CD34+ boost 14 DLI | MAC: 18% mixed RIC: 65% mixed Mixed chimerism in RIC was less in patients who received distal aleumtuzumab (29%) vs 79% in proximal alemtuzumab (p = 0.02) |
Rao, 2005 [49] | 1998–2001 | 33 6 SCID 27 non-SCID | 5.9 (0.19–18) | 22 MUD 11 MMUD All marrow | Flu 150 mg/m2 Melp 140 mg/m2 Alemtuzumab 1 mg/kg CSA | 13 (range, 8–34) | 0 | II–IV: 9 | Limited: 0 Extensive: 3 | 94% | NA | NA | NA | 55% had full chimerism 32% had high level mixed chimerism 6.5% had low level mixed chimerism 6.5% very low mixed chimerism |
Amrolia, 2000 [31] | NA | 8 3 SCID 1 XLP/HLH 2 CID 2 CD40 ligand def | 6.5 (range, 0.75–18) | 2 MSD 6 MUD All marrow | Flu 150 mg/m2 Melp 140 mg/m2 ALG 10 mg/kg GvHD prophylaxis CSA and steroid | 13 (range, 9–17) | 0 | I: 50 II–IV: 0 | limited cGvHD, n = 1 | 88 | NA | 1 patient | None | 4 had 100% donor chimerism 3 had mixed chimerism |
Fludarabine and low-dose TBI | ||||||||||||||
Burroughs, 2010 [36] | NA | 2 IPEX | 0.75, 16 | 2 MUD 1 marrow 1 PBSC | Flu 90 mg/m2 TBI 4Gy GvHD prophylaxis CSA and MMF | 16, 17 | 0 | 2 had grade II | 1 severe | Both alive | Both engrafted | None | None | Full immune function and normal FOXP3 protein expression |
Burroughs, 2007 [35] | 1998–2006 | 14 PID | Range 0.5–30 | 8 MFD 8 MUD 8 marrow 5 PBSC 1 CB | Flu 90 mg/m2 (n = 13) TBI 2Gy (n = 14) GvHD prophylaxis CSA and MMF | 15 (range 5–23) | 0 | II: 71 III–IV: 7 | Extensive: 47 | 62 | 62 | 1 | 1 unconditioned PBSC for slipping myeloid chimerism 1 conditioned HCT for persistent thrombocytopenia 1 DLI for low donor CD4 and CD8 chimerism 1 conditioned HCT for graft failure | 5 mixed chimerism 8 full donor chimerism |
Antibody-based conditioning | ||||||||||||||
Schulz, 2011 [44] | 2003–2007 | 14 non-malignant 4 SCID 2 CGD 2 Hyper IgM 2 other PID 4 H-globinopahty | 7.5 (range, 1–20) | 3 MFD 1 MMFD 8 MUD 2 HID 8 marrow 4 PBSC 2 TCD-PBSC | 90Y-labeled anti-CD66 antibody at Day −14 Fludarabine 160 mg/m2 Melphalan 70-140 mg/m2 ATG for mismatched donor and unrelated donor | NA | 0 | II: 36 III–IV: 0 | limited, n = 2 extended, n = 3 | 88 | 81 | n = 1 | 1 | 9 had 100% chimerism 2 had mixed chimerism |
Straathof, 2009 [24] | 1999–2002 | 16 8 SCID 1 MHC class II def. 1 IPEX 1 HLH 1 DKC + SCID 1 Ligase 4 def. 1 CD40 ligand def. 2 Other PIDs | 0.7 (range, 0.4 to 11.4) | 5 MSD 9 MUD 2 MMUDD 40 marrow 12 PBSC 1 PBSC + marrow 17 CB | Anti-CD45 1.6 mg/kg (day − 5 to − 2) Flu 150 mg/m2 Alemtuzumab 0.3 to 0.6 mg/kg GvHD prophylaxis CSA and MMF | 9.5 (range 1–15) | 0 | II–IV: 38 III–IV: 19 | 31 | 81 | 95 | 3 | 1 s HCT | Median myeloid: 100% (range, 41–100%) Median lymphocyte: 100% (range, 54–100%) |
Fludarabine and Treosulfan
Fludarabine and Busulfan
RIC in PID
Fludarabine and Melphalan
Minimal Intensity Conditioning for PID
Fludarabine and Low-Dose TBI
Antibody-Based
Anti-CD45 Antibodies
Radioimmunotherapy
Anti-CD117 Antibodies
Conditioning for Haploidentical Donor Transplant
Author, year | Year of HCT | No of patients/diagnosis | Median age at HCT (range), years | Donor and stem cell source | Conditioning regimen and GvHD prophylaxis | Median day of N engraftment | VOD % | aGvHD % | cGvHD % | OS % | ES % | Graft failure % | Second procedure, n | Latest donor chimerism/remarks |
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Fludarabine and treosulfan | ||||||||||||||
Neven, 2019 [48] | 2014–2017 | 22 PID 5 osteopetrosis 21 first HCT 6 s HCT | 1.5 (0.2–17) | 27 HID All marrow | 20 MAC with Bu-pk + Flu 160 mg/m2 (4 received additional Cy 28 mg/kg) Serotherapy: rituximab plus alemtuzumab/ATG 7 had RIC (1 first HCT and 6 s HCT) GVHD prophylaxis CSA MMF PTCy 50 mg/kg on day 3 + 4 | 11 | II–IV: 48 II: n = 10 III: n = 2 | 24.2 | 77.7 | 77.7 | n = 2 | 1 | 24 full chimerism 1 mixed chimerism | |
Shah, 2018 [5] | 2012–2016 | 25 PID 3 for refractory GvHD | 1.75 (0.28–10.3) | 23 HID 2 MMUD TCR ab/CD 19 depleted PBSC | Flu 150 mg/m2 Treo 36-42 mg/m2 TT 10 mg/kg 24 had serotherapy (ATG/alemtuzumab) 6 had rituximab 3 SCID: unconditioned GvHD prophylaxis: CSF/MMF | 0 | II–IV: 22 | None | 83.9 | 80.4 | n = 1 | 1 | 76.1% full donor chimerism 5 had high T cell but mixed myeloid chimerism (2 unconditioned) | |
Rastogi, 2017 [47] | 2013–2016 | 8 PID | 4.9 (0.8–12) | 7 HID 1 MUD Unmanipulated marrow/PBSC | 5 Flu 160 mg/m2 + Cy 29 mg/kg + TBI 2Gy (3 had additional TT) + ATG/alemtuzumab 2 Flu 160 mg/m2 + Treo 42 mg/2 1 Flu 160 mg/m2 + Bu 3.2 mg/kg GVHD prophylaxis Tacrolimus MMF PTCy 50 mg/kg on Day 3 + 4 | Mean 17 | NA | I–II: 3 patients II–IV: none | 2 limited | 75 | 75 | None | None | All full donor chimerism |
Balashov, 2015 [51] | 2012–2014 | 37 PID 5 SICD 32 non-SCID PID | 2.6 (0.2–17) | 27 MUD 10 MMRD TCR ab/CD 19 depleted PBSC | Flu 150 mg/m2 Treo 36-42 mg/m2 8 had Melphalan 140 mg/m2 for high risk graft rejection 14 had rituximab 1 unconditioned Serotherapy 35 ATG 2 alemtuzumab | 16 (range 11–28) | NA | Max grade 2 in 7 patients Only one had grade IV (no conditioning) | 1 patient (unconditioned) | 96.7 | 67.7 | 27% HID: 36% MUD: 28% | 10 | NA |