T-cell immune constitution after peripheral blood mononuclear cell transplantation in complete DiGeorge syndrome

Br J Haematol. 2002 Jun;117(4):899-906. doi: 10.1046/j.1365-2141.2002.03496.x.

Abstract

Complete DiGeorge syndrome (cDGS) is a congenital disorder characterized by typical facies, thymic aplasia, susceptibility to infections, hypoparathyroidism and conotruncal cardiac defect. Fetal thymus or post-natal thymus tissue transplantations and human leucocyte antigen (HLA)-genoidentical bone marrow transplantations were followed in a few cases by immune reconstitution. More recently, a peripheral blood mononuclear cell transplantation (PBMCT) was performed with an HLA-genoidentical donor and followed by a partial T-cell engraftment and immune reconstitution. We report a boy with cDGS, without cardiac defect, who suffered recurrent severe infections. At the age of 4 years, he underwent PBMCT from his HLA-genoidentical sister. He received no conditioning regimen, but graft-versus-host disease (GVHD) prophylaxis was with oral cyclosporin A and mycophenolate mofetil. Toxicity was mild, with grade I acute GVHD. The patient is currently 2.5 years post-PBMCT with excellent clinical performances. Mixed chimaerism can only be observed on the T-cell population (50% donor T cells). T-lymphocyte count fluctuated (CD3 more than 400 x 10(6)/l at d 84 and CD4 more than 200 x 10(6)/l at d 46). Exclusive memory phenotype T cells and absence of new thymic emigrants suggest expansion of infused T cells. T-cell mitogen and tetanus antigen responses normalized a few months after transplantation. After immunizations, specific antibodies were produced. PBMCT from an HLA identical sibling could be an efficient treatment of immune deficiency in cDGS.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • CD4-Positive T-Lymphocytes / immunology
  • CD8-Positive T-Lymphocytes / immunology
  • DiGeorge Syndrome / immunology*
  • DiGeorge Syndrome / surgery*
  • Graft vs Host Disease / immunology
  • Humans
  • Immunization
  • Infant, Newborn
  • Leukocytes, Mononuclear / transplantation*
  • Lymphocyte Count
  • Male
  • Polymorphism, Genetic
  • Postoperative Period
  • T-Lymphocytes / immunology*
  • Transplantation Chimera
  • Transplantation, Isogeneic