Abstract

Hematopoietic stem cell transplantation is standard therapy for numerous hematological diseases. The use of haploidentical donors, sharing half of the HLA alleles with the recipient, has facilitated the use of this procedure as patients can rely on availability of a haploidentical donor within their family. Since HLA disparity increases the risk of graft-versus-host disease, T-cell depletion has been used to remove alloreactive lymphocytes from the graft. Selective removal of αβ T cells, which encompass the alloreactive repertoire, combined with removal of B cells to prevent EBV-related lymphoproliferative disease, proved safe and effective in clinical studies. Depleted αβ T cells and B cells are generally discarded as by-products. Considering the possible use of donor T cells for donor lymphocyte infusions or for generation of pathogen-specific T cells as mediators of graft-versus-infection effect, we tested whether cells in the discarded fractions were functionally intact. Response to alloantigens and to viral antigens comparable to that of unmanipulated cells indicated a functional integrity of αβ T cells, in spite of the manipulation used for their depletion. Furthermore, B cells proved to be efficient antigen-presenting cells, indicating that antigen uptake, processing, and presentation were fully preserved. Therefore, we propose that separated αβ T lymphocytes could be employed for obtaining pathogen-specific T cells, applying available methods for positive selection, which eventually leads to indirect allodepletion. In addition, these functional T cells could undergo additional manipulation, such as direct allodepletion or genetic modification.

Highlights

  • HLA-haploidentical hematopoietic stem cell transplantation from a related donor is a suitable option for patients affected by many malignant and non-malignant hematological diseases [1,2,3]

  • Most CD34 HSC, natural killer (NK) cells, and γδ T cells were recovered in the collection bag (CB) fractions

  • A remarkable depletion was achieved for αβ T cells and B cells, with mean values of around 12,000 × 106 and 3,000 × 106 in the Aph samples versus 1 × 106 and 0.8 × 106 in the CB fractions

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Summary

Introduction

HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) from a related donor is a suitable option for patients affected by many malignant and non-malignant hematological diseases [1,2,3]. The first procedure, based on removal of αβ T cells with anti αβ TCR antibodies bound on paramagnetic microbeads, which are retained by a magnetic column, is commercially available with certified reagents, protocols, and automated instrumentation (Miltenyi Biotec, Bergish Gladbach, Germany). This procedure includes concomitant removal of B cells with anti-CD19 antibodies with the purpose of reducing the risk of EBV-associated posttransplant lymphoproliferative disease. Clinical results demonstrating the safety and efficacy of this procedure have been recently reported [21,22,23]

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