Article
作者: Gennery, Andrew R ; Sebire, Neil ; Boztug, Kaan ; Marzollo, Antonio ; André, Isabelle ; Rai, Rajeev ; Golwala, Zainab M ; Evans, Grace ; De Braem, Victoria Bordon Cueto ; Sellmer, Anna ; Lizot, Sabrina ; Holm, Mette ; Obiri-Yeboa, Irene ; Nademi, Zohreh ; Garrigue, Alexandrine ; Kusters, Maaike A ; Buckland, Matthew ; Hackett, Scott ; Kreins, Alexandra Y ; Thrasher, Adrian J ; Ocampo-Godinez, Juan Moises ; Worth, Austen ; Adams, Stuart ; Torpiano, Paul ; Soler-Palacin, Pere ; Nierkens, Stefan ; Davies, E Graham ; Pichler, Herbert ; Klocperk, Adam ; Schmid, Jana Pachlopnik ; Corredera, Marta Martin ; Goncalves, Helena Spiridou ; Marcus, Nufar ; Gilmour, Kimberly ; Awuah, Arnold ; Howley, Evey ; van Montfrans, Joris ; Moirangthem, Ranjita Devi ; Soomann, Maarja ; Bernard, Fanette ; de Koning, Coco ; Kricke, Susanne ; Cole, Theresa ; Hambleton, Sophie
Persistent selective T-lymphocytopaenia is found both in SCID and congenital athymia. Without molecular diagnosis, it is challenging to determine whether HCT or thymus transplantation ought to be performed. Ex vivo T-lymphopoiesis assays have been proposed to assist clinical decision-making for genetically undefined patients. We investigated 20 T-lymphocytopaenic patients, including 13 patients awaiting first-line treatment and 7 patients with failed immune reconstitution after previous HCT or thymus transplantation. Whilst developmental blocks in ex vivo T-lymphopoiesis indicated haematopoietic cell-intrinsic defects, successful T-lymphocyte differentiation required careful interpretation, in conjunction with clinical status, immunophenotyping, and genetic investigations. Of the 20 patients, 13 proceeded to treatment, with successful immune reconstitution observed in 4 of the 6 patients post-HCT and 4 of the 7 patients after thymus transplantation, the latter including two patients who had previously undergone HCT. Whilst further validation and standardization are required, we conclude that assessing ex vivo T-lymphopoiesis during the diagnostic pathway for genetically undefined T-lymphocytopaenia improves patient outcomes by facilitating corrective treatment choice.