Phase 1/2: CD45RA Depleted Stem Cell Addback to Prevent Viral or Fungal Infections Post TCRab/CD19 Depleted HSCT

The major morbidities of allogeneic hematopoietic stem cell transplant (HSCT) using donors that are not human leukocyte antigen (HLA) matched siblings are graft vs host disease (GVHD) and life- threatening infections. T cell receptor alpha beta (TCRαβ) T lymphocyte depletion and CD19+ B lymphocyte depletion of alternative donor hematopoietic stem cell (HSC) grafts is effective in preventing GVHD, but immune reconstitution may be delayed, increasing the risk of infections. The central hypothesis of this study is that an addback of CD45RO memory T lymphocytes, derived from a fraction of the original donor peripheral stem cell product depleted of CD45RA naïve T lymphocytes, will accelerate immune reconstitution and help decrease the risk of infections in TCRab/CD19 depleted PSCT.

Sex

All

Minimum age

1 Month

Maximum age

25 Years

Inclusion Criteria:

1. Disease for which allogeneic HSCT may be curative.
2. Remission status of hematologic malignancies and additional disease-specific eligibility determinations will be according to standards of practice within the CHOP Cellular Immunotherapy and Transplant Program (CTTS).
3. Patients must be 25 years of age and less
4. Evaluation for organ and infectious status as per our CTTS standard operating procedure.
5. Signed consent by parent/guardian or able to give consent if 18 years of age and older.
6. Participants of childbearing potential must have a negative pregnancy test as per institutional SOP.

Exclusion Criteria:

1. Patients who have performance score less than 60.
2. No suitable donor available for mobilized peripheral stem cells.
3. Patients with Hodgkin lymphoma or non-Burkitt, non-lymphoblastic lymphoma.
4. Planned receipt of alemtuzumab during conditioning.
5. Patients with an available 10/10 HLA matched sibling donor.
6. Patients who do not meet institutional disease, organ or infectious criteria.

Donor selection and eligibility:

1. Unrelated donor meets National Marrow Donor Program criteria for donation.
2. Related donor (at least haploidentical) willing and able to donate mobilized peripheral stem cells.
3. HLA testing/matching

   * HLA testing to be done by molecular methods for A, B, C, DRB1, DQB1
   * Related donor: Must be ≥ 5/10 match
   * Unrelated donor: 10/10 or 9/10 match
   * KIR typing for haploidentical donor for hematologic malignancies
   * Donor specific HLA antibodies (DSA) should be assessed for all subjects receiving an HLA mismatched graft (≤ 9/10).
4. Donor must be willing to undergo granulocyte colony stimulating factor (GCSF) mobilization and peripheral blood stem cell collection
5. Donors must be willing to sign consent to participate in this study.

• BACKGROUNDZvyagin IV, Mamedov IZ, Tatarinova OV, Komech EA, Kurnikova EE, Boyakova EV, Brilliantova V, Shelikhova LN, Balashov DN, Shugay M, Sycheva AL, Kasatskaya SA, Lebedev YB, Maschan AA, Maschan MA, Chudakov DM. Tracking T-cell immune reconstitution after TCRalphabeta/CD19-depleted hematopoietic cells transplantation in children. Leukemia. 2017 May;31(5):1145-1153. doi: 10.1038/leu.2016.321. Epub 2016 Nov 4. PMID 27811849
• BACKGROUNDAnderson BE, McNiff J, Yan J, Doyle H, Mamula M, Shlomchik MJ, Shlomchik WD. Memory CD4+ T cells do not induce graft-versus-host disease. J Clin Invest. 2003 Jul;112(1):101-8. doi: 10.1172/JCI17601. PMID 12840064
• BACKGROUNDZheng H, Matte-Martone C, Li H, Anderson BE, Venketesan S, Sheng Tan H, Jain D, McNiff J, Shlomchik WD. Effector memory CD4+ T cells mediate graft-versus-leukemia without inducing graft-versus-host disease. Blood. 2008 Feb 15;111(4):2476-84. doi: 10.1182/blood-2007-08-109678. Epub 2007 Nov 28. PMID 18045967
• BACKGROUNDTeschner D, Distler E, Wehler D, Frey M, Marandiuc D, Langeveld K, Theobald M, Thomas S, Herr W. Depletion of naive T cells using clinical grade magnetic CD45RA beads: a new approach for GVHD prophylaxis. Bone Marrow Transplant. 2014 Jan;49(1):138-44. doi: 10.1038/bmt.2013.114. Epub 2013 Aug 12. PMID 23933765
• BACKGROUNDBleakley M, Heimfeld S, Jones LA, Turtle C, Krause D, Riddell SR, Shlomchik W. Engineering human peripheral blood stem cell grafts that are depleted of naive T cells and retain functional pathogen-specific memory T cells. Biol Blood Marrow Transplant. 2014 May;20(5):705-16. doi: 10.1016/j.bbmt.2014.01.032. Epub 2014 Feb 11. PMID 24525279
• BACKGROUNDBleakley M, Heimfeld S, Loeb KR, Jones LA, Chaney C, Seropian S, Gooley TA, Sommermeyer F, Riddell SR, Shlomchik WD. Outcomes of acute leukemia patients transplanted with naive T cell-depleted stem cell grafts. J Clin Invest. 2015 Jul 1;125(7):2677-89. doi: 10.1172/JCI81229. Epub 2015 Jun 8.