Posttransplantation late complications increase over time for patients with SCID: A Primary Immune Deficiency Treatment Consortium (PIDTC) landmark study

Hesham Eissa, Monica S. Thakar, Ami J. Shah, Brent R. Logan, Linda M. Griffith, Huaying Dong, Roberta E. Parrott, Richard J. O'Reilly, Jasmeen Dara, Neena Kapoor, Lisa Forbes Satter, Sharat Chandra, Malika Kapadia, Shanmuganathan Chandrakasan, Alan Knutsen, Soma C. Jyonouchi, Lyndsay Molinari, Ahmad Rayes, Christen L. Ebens, Pierre TeiraBlachy J. Dávila Saldaña, Lauri M. Burroughs, Sonali Chaudhury, Deepak Chellapandian, Alfred P. Gillio, Fredrick Goldman, Harry L. Malech, Kenneth DeSantes, Geoff D.E. Cuvelier, Jacob Rozmus, Ralph Quinones, Lolie C. Yu, Larisa Broglie, Victor Aquino, Evan Shereck, Theodore B. Moore, Mark T. Vander Lugt, Talal I. Mousallem, Joeseph H. Oved, Morna Dorsey, Hisham Abdel-Azim, Caridad Martinez, Jacob H. Bleesing, Susan Prockop, Donald B. Kohn, Jeffrey J. Bednarski, Jennifer Leiding, Rebecca A. Marsh, Troy Torgerson, Luigi D. Notarangelo, Sung Yun Pai, Michael A. Pulsipher, Jennifer M. Puck, Christopher C. Dvorak, Elie Haddad, Rebecca H. Buckley, Morton J. Cowan, Jennifer Heimall

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The Primary Immune Deficiency Treatment Consortium (PIDTC) enrolled children in the United States and Canada onto a retrospective multicenter natural history study of hematopoietic cell transplantation (HCT). Objective: We investigated outcomes of HCT for severe combined immunodeficiency (SCID). Methods: We evaluated the chronic and late effects (CLE) after HCT for SCID in 399 patients transplanted from 1982 to 2012 at 32 PIDTC centers. Eligibility criteria included survival to at least 2 years after HCT without need for subsequent cellular therapy. CLE were defined as either conditions present at any time before 2 years from HCT that remained unresolved (chronic), or new conditions that developed beyond 2 years after HCT (late). Results: The cumulative incidence of CLE was 25% in those alive at 2 years, increasing to 41% at 15 years after HCT. CLE were most prevalent in the neurologic (9%), neurodevelopmental (8%), and dental (8%) categories. Chemotherapy-based conditioning was associated with decreased-height z score at 2 to 5 years after HCT (P < .001), and with endocrine (P < .001) and dental (P = .05) CLE. CD4 count of ≤500 cells/μL and/or continued need for immunoglobulin replacement therapy >2 years after transplantation were associated with lower-height z scores. Continued survival from 2 to 15 years after HCT was 90%. The presence of any CLE was associated with increased risk of late death (hazard ratio, 7.21; 95% confidence interval, 2.71-19.18; P < .001). Conclusion: Late morbidity after HCT for SCID was substantial, with an adverse impact on overall survival. This study provides evidence for development of survivorship guidelines based on disease characteristics and treatment exposure for patients after HCT for SCID.

Original languageEnglish (US)
Pages (from-to)287-296
Number of pages10
JournalJournal of Allergy and Clinical Immunology
Volume153
Issue number1
DOIs
StatePublished - Jan 2024

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology

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