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Novel diagnostic procedure
CASE REPORT
Optimal approach to assessing T-cell function in haematopoietic cell transplant recipients
  1. Joshua M Dorn1,
  2. Roshini S Abraham2,
  3. Vilmarie Rodriguez3,
  4. Shakila P Khan3,
  5. Heather Stefanski4,
  6. Avni Joshi5
  1. 1 Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Division of Pediatric Hematology/Oncology, Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
  4. 4 Division of Pediatric Blood and Marrow Transplant, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
  5. 5 Division of Pediatric Allergy and Immunology, Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Avni Joshi, joshi.avni{at}mayo.edu

Summary

Standardised approaches to functional immune assessment after haematopoietic cell transplantation (HCT) are lacking. A 12-year-old girl with relapsed acute myelogenous leukaemia, 2 years post-unrelated HCT, underwent immunological evaluation prior to receiving live vaccinations. Assessment of standard immune parameters and T-cell proliferation to phytohaemagglutinin was reassuring. She was given Varicella vaccination based on usual post-transplant protocols but was hospitalised 10 days later with localised Varicella infection (vaccine strain). Following recovery, she underwent further assessment that showed reduced T-cell proliferation to an anti-CD3 stimulation panel (anti-CD3 alone, soluble anti-CD3+ anti-CD28 and soluble anti-CD3+ plus exogenous IL-2). On reassessment, 7 months later, T-cell responses to anti-CD3 stimulation were normal and she was revaccinated without further incident. Measurement of T-cell proliferation to anti-CD3 stimulants likely yields more useful information about global T-cell function and should be strongly considered prior to live vaccine administration post-allogeneic haematopoietic transplant.

  • immunological products and vaccines
  • infections
  • malignant disease and immunosuppression
  • immunology
  • vaccination/immunisation

https://doi.org/10.1136/bcr-2017-222417

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    Footnotes

    • Contributors JMD: Involved in planning, data acquisition and analysis and interpretation of data for the article. Involved in drafting, editing and revising the article critically for important intellectual content. Gives full final approval of the version submitted. Agrees to be accountable for the article and to ensure that all questions regarding accuracy or integrity are investigated and resolved. RSA: Involved in planning, data acquisition and analysis and interpretation of data for the article. Involved in drafting, editing and revising the article critically for important intellectual content. Gives full final approval of the version submitted. Agrees to be accountable for the article and to ensure that all questions regarding accuracy or integrity are investigated and resolved. Vilmarie Rodriguez: Involved in planning, data acquisition and analysis and interpretation of data for the article. Involved in drafting, editing and revising the article critically for important intellectual content. Gives full final approval of the version submitted. Agrees to be accountable for the article and to ensure that all questions regarding accuracy or integrity are investigated and resolved. SPK: Involved in planning, data acquisition and analysis and interpretation of data for the article. Involved in drafting, editing and revising the article critically for important intellectual content. Gives full final approval of the version submitted. Agrees to be accountable for the article and to ensure that all questions regarding accuracy or integrity are investigated and resolved. Heather Stefanski: Involved in planning, data acquisition and analysis and interpretation of data for the article. Involved in drafting, editing and revising the article critically for important intellectual content. Gives full final approval of the version submitted. Agrees to be accountable for the article and to ensure that all questions regarding accuracy or integrity are investigated and resolved. AJ: Involved in planning, data acquisition and analysis and interpretation of data for the article. Involved in drafting, editing and revising the article critically for important intellectual content. Gives full final approval of the version submitted. Agrees to be accountable for the article and to ensure that all questions regarding accuracy or integrity are investigated and resolved.

    • Competing interests None declared.

    • Patient consent Guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.