Cord blood transplantation (CBT) is curative for many primary immunodeficiencies (PIDs) but is associated with risks of viral infection and graft-versus-host disease (GvHD). Serotherapy reduces GvHD but potentially increases the risk of viral infection by delaying immune reconstitution. Because many PID patients have pre-existing viral infections, the optimal dose of serotherapy is unclear. We performed a retrospective analysis in 34 consecutive PID patients undergoing CBT and compared immune reconstitution, viral infection, GvHD, mortality, and long-term immune function between high-dose (n=11) and low-dose (n=9) serotherapy. Serotherapy dose had no effect on neutrophil engraftment. Median CD3+ engraftment occurred at 92.5 and 97days for high- and low-dose serotherapy, respectively. The low-dose serotherapy group had higher CD3+, CD4+, and early thymic emigrant counts at 4months compared with the high-dose group. GvHD severity and number of viral infections did not differ between serotherapy doses. Survival from the transplantation process was 90.9% for high-dose and 100% for low-dose groups. In conclusion, low-dose serotherapy enhanced T cell reconstitution and thymopoiesis during the first year after CBT with no increase in GvHD. © 2014 American Society for Blood and Marrow Transplantation.
Lane, J. P., Evans, P. T. G., Nademi, Z., Barge, D., Jackson, A., Hambleton, S., … Gennery, A. R. (2014). Low-dose serotherapy improves early immune reconstitution after cord blood transplantation for primary immunodeficiencies. Biology of Blood and Marrow Transplantation, 20(2), 243–249. https://doi.org/10.1016/j.bbmt.2013.11.005