Functionality testing of stem cell grafts to predict infectious complications after allogeneic hematopoietic stem cell transplantation

Nilsson, J.; Granrot, I.; Mattsson, J.; Omazic, B.; Uhlin, M.; Thunberg, S.

BACKGROUND AND OBJECTIVES: Allogeneic hematopoietic stem cell transplantation (HSCT) is a routine clinical procedure performed to treat patients with haematological malignancies, primary immune deficiencies or metabolic disorders. Infections during lymphopenia after allogeneic HSCT are associated with high mortality and morbidity. Typical infectious agents are Epstein–Barr virus, cytomegalovirus, herpes simplex virus, varicella‐zoster virus and fungi. The study aim was to evaluate whether measurement of the responses of antigen‐specific T‐cells, recognizing infectious pathogens would correlate to protective functions in the stem cell recipient post‐transplant. MATERIALS AND METHODS: Twenty‐one grafts were analysed by flow cytometry and cells were stimulated in vitro with relevant infectious antigens, followed by evaluation of T‐cell proliferation and cytokine production. Results were compared to the recipients’ clinical records 1‐year post‐transplantation. RESULTS: We show that an extensive repertoire of transferred antigen‐specific T‐cells from allogeneic donor grafts against infectious agents, involved in post‐transplant infections, are linked to an absence of infectious complications for the recipient up‐to 1‐year post‐transplant. The protective effect was associated with antigen‐specific T‐cell proliferation and IL‐1β secretion. CONCLUSION: Our results suggest that assaying T‐cell function before HSCT could determine individual risks for infectious complications and thus aid in clinical decision‐making regarding prophylactic and pre‐emptive anti‐infective therapy.