Allogeneic bone marrow transplantation for patients with treatment-refractory Crohn's Disease
Background & aims: Durable remissions of Crohn's Disease (CD) have followed myeloablative conditioning therapy and allogeneic marrow transplantation. For patients with treatment-refractory disease, we used reduced-intensity conditioning to minimize toxicity, marrow from donors with low...
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| Format: | Article |
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Elsevier
2024-01-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024000574 |
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| author | George B. McDonald Ole J.B. Landsverk Dermot P.B. McGovern Anders Aasebø Vemund Paulsen Talin Haritunians Henrik M. Reims Bernadette M. McLaughlin Timothy Zisman Dalin Li Elisabeth T.M.M. Elholm Frode L. Jahnsen George E. Georges Tobias Gedde-Dahl |
| author_facet | George B. McDonald Ole J.B. Landsverk Dermot P.B. McGovern Anders Aasebø Vemund Paulsen Talin Haritunians Henrik M. Reims Bernadette M. McLaughlin Timothy Zisman Dalin Li Elisabeth T.M.M. Elholm Frode L. Jahnsen George E. Georges Tobias Gedde-Dahl |
| author_sort | George B. McDonald |
| collection | DOAJ |
| description | Background & aims: Durable remissions of Crohn's Disease (CD) have followed myeloablative conditioning therapy and allogeneic marrow transplantation. For patients with treatment-refractory disease, we used reduced-intensity conditioning to minimize toxicity, marrow from donors with low Polygenic Risk Scores for CD as cell sources, and protracted immune suppression to lower the risk of graft-versus-host disease (GVHD). Our aim was to achieve durable CD remissions while minimizing transplant-related complications. Methods: DNA from patients and their HLA-matched unrelated donors was genotyped and Polygenic Risk Scores calculated. Donor marrow was infused following non-myeloablative conditioning. Patient symptoms and endoscopic findings were documented at intervals after transplant. Results: We screened 807 patients, 143 of whom met eligibility criteria; 2 patients received allografts. Patient 1 had multiple complications and died at day 332 from respiratory failure. Patient 2 had resolution of CD symptoms until day 178 when CD recurred, associated with persistent host chimerism in both peripheral blood and intestinal mucosa. Withdrawal of immune suppression was followed by dominant donor immune chimerism in peripheral blood and resolution of CD findings. Over time, mucosal T-cells became donor-dominant. At 5 years after allografting, Patient 2 remained off all medications but had mild symptoms related to a jejunal stricture that required stricturoplasty at 6 years. At 8 years, she remains stable off medications. Conclusions: The kinetics of immunologic chimerism after allogeneic marrow transplantation for CD patients depends on the intensity of the conditioning regimen and the magnitude of immune suppression. One patient achieved durable improvement of her previously refractory CD only after establishing donor immunologic chimerism in intestinal mucosa. Her course provides proof-of-principal for allografting as a potential treatment for refractory CD, but an immunoablative conditioning regimen should be considered for future studies.(ClinicalTrials.gov, NCT01570348) |
| first_indexed | 2024-03-08T09:01:49Z |
| format | Article |
| id | doaj.art-bdeefb3eb92c4e6ab5819534e0b1348b |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-08T09:01:49Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-bdeefb3eb92c4e6ab5819534e0b1348b2024-02-01T06:34:27ZengElsevierHeliyon2405-84402024-01-01101e24026Allogeneic bone marrow transplantation for patients with treatment-refractory Crohn's DiseaseGeorge B. McDonald0Ole J.B. Landsverk1Dermot P.B. McGovern2Anders Aasebø3Vemund Paulsen4Talin Haritunians5Henrik M. Reims6Bernadette M. McLaughlin7Timothy Zisman8Dalin Li9Elisabeth T.M.M. Elholm10Frode L. Jahnsen11George E. Georges12Tobias Gedde-Dahl13Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Corresponding author. Gastroenterology/Hepatology Section (D5-369), Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109-1024, USA.Department of Pathology, Oslo University Hospital, Oslo, NorwayF. Widjaja Foundation Inflammatory Bowel & Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USADepartment of Pathology, Oslo University Hospital, Oslo, NorwayDepartment of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital Rikshospitalet, NorwayF. Widjaja Foundation Inflammatory Bowel & Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USADepartment of Pathology, Oslo University Hospital, Oslo, NorwayClinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USADepartment of Medicine, University of Washington School of Medicine, Seattle, WA, USAF. Widjaja Foundation Inflammatory Bowel & Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USAClinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; Department of Hematology, Oslo University Hospital, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, NorwayDepartment of Pathology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, NorwayClinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USADepartment of Hematology, Oslo University Hospital, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, NorwayBackground & aims: Durable remissions of Crohn's Disease (CD) have followed myeloablative conditioning therapy and allogeneic marrow transplantation. For patients with treatment-refractory disease, we used reduced-intensity conditioning to minimize toxicity, marrow from donors with low Polygenic Risk Scores for CD as cell sources, and protracted immune suppression to lower the risk of graft-versus-host disease (GVHD). Our aim was to achieve durable CD remissions while minimizing transplant-related complications. Methods: DNA from patients and their HLA-matched unrelated donors was genotyped and Polygenic Risk Scores calculated. Donor marrow was infused following non-myeloablative conditioning. Patient symptoms and endoscopic findings were documented at intervals after transplant. Results: We screened 807 patients, 143 of whom met eligibility criteria; 2 patients received allografts. Patient 1 had multiple complications and died at day 332 from respiratory failure. Patient 2 had resolution of CD symptoms until day 178 when CD recurred, associated with persistent host chimerism in both peripheral blood and intestinal mucosa. Withdrawal of immune suppression was followed by dominant donor immune chimerism in peripheral blood and resolution of CD findings. Over time, mucosal T-cells became donor-dominant. At 5 years after allografting, Patient 2 remained off all medications but had mild symptoms related to a jejunal stricture that required stricturoplasty at 6 years. At 8 years, she remains stable off medications. Conclusions: The kinetics of immunologic chimerism after allogeneic marrow transplantation for CD patients depends on the intensity of the conditioning regimen and the magnitude of immune suppression. One patient achieved durable improvement of her previously refractory CD only after establishing donor immunologic chimerism in intestinal mucosa. Her course provides proof-of-principal for allografting as a potential treatment for refractory CD, but an immunoablative conditioning regimen should be considered for future studies.(ClinicalTrials.gov, NCT01570348)http://www.sciencedirect.com/science/article/pii/S2405844024000574Mucosal immune chimerismPolygenic risk scoreOutcomesReduced-intensity conditioningCrohn's disease |
| spellingShingle | George B. McDonald Ole J.B. Landsverk Dermot P.B. McGovern Anders Aasebø Vemund Paulsen Talin Haritunians Henrik M. Reims Bernadette M. McLaughlin Timothy Zisman Dalin Li Elisabeth T.M.M. Elholm Frode L. Jahnsen George E. Georges Tobias Gedde-Dahl Allogeneic bone marrow transplantation for patients with treatment-refractory Crohn's Disease Heliyon Mucosal immune chimerism Polygenic risk score Outcomes Reduced-intensity conditioning Crohn's disease |
| title | Allogeneic bone marrow transplantation for patients with treatment-refractory Crohn's Disease |
| title_full | Allogeneic bone marrow transplantation for patients with treatment-refractory Crohn's Disease |
| title_fullStr | Allogeneic bone marrow transplantation for patients with treatment-refractory Crohn's Disease |
| title_full_unstemmed | Allogeneic bone marrow transplantation for patients with treatment-refractory Crohn's Disease |
| title_short | Allogeneic bone marrow transplantation for patients with treatment-refractory Crohn's Disease |
| title_sort | allogeneic bone marrow transplantation for patients with treatment refractory crohn s disease |
| topic | Mucosal immune chimerism Polygenic risk score Outcomes Reduced-intensity conditioning Crohn's disease |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024000574 |
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