When reviewing nearly 3 decades of publications on adoptive T-cell transfer, the reviewers found a total of 74% of immunocompromised patients had responded to this technique. In particular, 62%, 74%, and 85% of patients responded to EBV-, AdV-, and CMV-specific T-cell transfer, respectively. In addition, treatment success has been reported using doses as small as a few hundred cells, though the use of higher doses has been reported in studies employing more complex in vitro culturing techniques.
Other Strategies for Immunosuppression After HSCT
Pamela S Becker, MD, PhD, of the division of hematology at the University of Washington in Seattle, told Hematology Advisor, “Antimicrobial prophylaxis and frequent monitoring for infection are the 2 best strategies to improve immunosuppression in adult patients undergoing allogeneic HSCT.”
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Parameswaran Hari, MD, MS, of the division of hematology and oncology at the Medical College of Wisconsin in Milwaukee, told Hematology Advisor, “In my opinion, the best strategy [to improve immunosuppression] is post-transplant cyclophosphamide, but this has not yet been studied in a randomized large study [that compares it with] other existing modalities.”
Possible Limitations and Future Directions
Novel development techniques have removed many of the manufacturing-related barriers to the advancement of virus-specific T-cell products. However, several logistical, regulatory, and time-related barriers still exist that must be addressed before widespread clinical application of this technique can become feasible. Safety and efficacy of adoptive T-cell transfer has not yet been established in placebo-controlled studies.
“Multinational efforts are required to clarify the status of cellular treatment in first-line clinical routine, with the overall objective of strengthening evidence-based treatment guidelines for refractory viral infections post-HSCT,” the reviewers concluded.
Reference
1. Kaeuferle T, Krauss R, Blaeschke F, et al. Strategies of adoptive T-cell transfer to treat refractory viral infections post allogeneic stem cell transplantation [published online February 6, 2019]. J Hematol Oncol. doi:10.1186/s13045-019-0701-1
