Outcome of hematopoietic stem cell transplantation for adenosine deaminase–deficient severe combined immunodeficiency

A Hassan, C Booth, A Brightwell… - Blood, The Journal …, 2012 - ashpublications.org
A Hassan, C Booth, A Brightwell, Z Allwood, P Veys, K Rao, M Hönig, W Friedrich…
Blood, The Journal of the American Society of Hematology, 2012ashpublications.org
Deficiency of the purine salvage enzyme adenosine deaminase leads to SCID (ADA-SCID).
Hematopoietic cell transplantation (HCT) can lead to a permanent cure of SCID; however,
little data are available on outcome of HCT for ADA-SCID in particular. In this multicenter
retrospective study, we analyzed outcome of HCT in 106 patients with ADA-SCID who
received a total of 119 transplants. HCT from matched sibling and family donors (MSDs,
MFDs) had significantly better overall survival (86% and 81%) in comparison with HCT from …
Abstract
Deficiency of the purine salvage enzyme adenosine deaminase leads to SCID (ADA-SCID). Hematopoietic cell transplantation (HCT) can lead to a permanent cure of SCID; however, little data are available on outcome of HCT for ADA-SCID in particular. In this multicenter retrospective study, we analyzed outcome of HCT in 106 patients with ADA-SCID who received a total of 119 transplants. HCT from matched sibling and family donors (MSDs, MFDs) had significantly better overall survival (86% and 81%) in comparison with HCT from matched unrelated (66%; P < .05) and haploidentical donors (43%; P < .001). Superior overall survival was also seen in patients who received unconditioned transplants in comparison with myeloablative procedures (81% vs 54%; P < .003), although in unconditioned haploidentical donor HCT, nonengraftment was a major problem. Long-term immune recovery showed that regardless of transplant type, overall T-cell numbers were similar, although a faster rate of T-cell recovery was observed after MSD/MFD HCT. Humoral immunity and donor B-cell engraftment was achieved in nearly all evaluable surviving patients and was seen even after unconditioned HCT. These data detail for the first time the outcomes of HCT for ADA-SCID and show that, if patients survive HCT, long-term cellular and humoral immune recovery is achieved.
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