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Blood, 1 January 2001, Vol. 97, No. 1, pp. 63-72
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Administration of herpes simplex-thymidine kinase-expressing
donor T cells with a T-cell-depleted allogeneic marrow graft
Pierre Tiberghien,
Christophe Ferrand,
Bruno Lioure,
Noël Milpied,
Régis Angonin,
Eric Deconinck,
Jean-Marie Certoux,
Eric Robinet,
Philippe Saas,
Bruno Petracca,
Chris Juttner,
Craig W. Reynolds,
Dan L. Longo,
Patrick Hervé, and
Jean-Yves Cahn
From the Etablissement Français du Sang,
Bourgogne/Franche-Comté, and Service d'Anatomie Pathologique and
Service d'Hématologie, Centre Hospitolier Universitoire (CHU)
Besançon, Besançon, France; Service d'Hématologie,
CHU Strasbourg, Strasbourg, France; Service d'Hématologie, CHU
Nantes, Nantes, France; Genetic Therapy Inc. (GTI)/Systemix/Novartis,
Palo Alto, CA; National Cancer Institute (NCI)-FCRDC, National
Institutes of Health (NIH), Frederick, MD; and the National Institute
on Aging, NIH, Baltimore, MD.
Administration of donor T cells expressing the herpes
simplex-thymidine kinase (HS-tk) with a hematopoietic stem cell (HSC) transplantation could allow, if graft-versus-host disease (GVHD) was to
occur, a selective in vivo depletion of these T cells by the use of
ganciclovir (GCV). The study evaluates the feasibility of such
an approach. Escalating numbers of donor HS-tk-expressing CD3+ gene-modified cells (GMCs) are infused with a
T-cell-depleted bone marrow transplantation (BMT). Twelve patients
with hematological malignancies received 2 × 105
(n = 5), 6 × 105 (n = 5), or 20 × 105
(n = 2) donor CD3+ GMCs/kg with a BMT from a human
leukocyte antigen (HLA)-identical sibling. No acute toxicity was
associated with GMC administration. An early increase of circulating
GMCs followed by a progressive decrease and long-lasting circulation of
GMCs was documented. GCV treatment resulted in significant rapid
decrease in circulating GMCs. Three patients developed acute GVHD, with
a grade of at least II, while one patient developed chronic GVHD.
Treatment with GCV alone was associated with a complete remission (CR)
in 2 patients with acute GVHD, while the addition of glucocorticoids was necessary to achieve a CR in the last case. Long-lasting CR occurred with GCV treatment in the patient with chronic GVHD. Unfortunately, Epstein-Barr virus-lymphoproliferative disease occurred
in 3 patients. Overall, the administration of low numbers of
HS-tk-expressing T cells early following an HLA-identical BMT is
associated with no acute toxicity, persistent circulation of the GMCs,
and GCV-sensitive GVHD. Such findings open the way to the infusion of
higher numbers of gene-modified donor T cells to enhance post-BMT
immune competence while preserving GCV-sensitive alloreactivity.
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