Abstract
Adoptive transfer of virus-specific T cells offers the potential for accelerating reconstitution of antigen-specific immunity after allogeneic hematopoietic stem cell transplantation. However, the logistics of producing virus-specific T cells and the risk of inducing graft-versus-host disease has limited their application. We developed a relatively simple system employing cytomegalovirus lysate-pulsed, monocyte-derived dendritic cells as stimulator cells, requiring only a single blood draw from the donor. We treated 16 patients with these T-cell lines, administered after the detection of human cytomegalovirus (HCMV) DNA by polymerase chain reaction. Massive in vivo expansions of HCMV-specific cytotoxic T lymphocytes (3-5 log) were observed within days of adoptive transfer. In eight cases viral titers were decreasing within 5 days and antiviral drug therapy was not required. The T-cell receptor CDR3 lengths of HCMV-specific cytotoxic T lymphocytes expanding in vivo were identical to those of the transferred cells. A low incidence of late CMV reactivation was seen (2/14 assessable patients compared with 45/72 historical controls, p = 0.001) and no significant toxicities were observed. Our findings indicate that application of cell lines generated in relatively short-term in vitro cultures is both feasible and effective in a clinical environment. This simple in vitro methodology should allow widespread application of adoptive transfer of virus-specific T cells.
MeSH terms
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Adoptive Transfer*
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Adult
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Antigens, Viral / immunology
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Antigens, Viral / pharmacology
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Antiviral Agents / pharmacology
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CD4-Positive T-Lymphocytes / cytology
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CD4-Positive T-Lymphocytes / immunology
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CD8-Positive T-Lymphocytes / cytology
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CD8-Positive T-Lymphocytes / immunology
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Cell Differentiation / immunology
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Cell Proliferation / drug effects
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Coculture Techniques
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Complementarity Determining Regions / chemistry
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Complementarity Determining Regions / immunology
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Cyclosporine / pharmacology
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Cytomegalovirus / immunology*
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Cytomegalovirus Infections / therapy*
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Cytotoxicity Tests, Immunologic
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DNA, Viral / blood
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Dendritic Cells / immunology
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Female
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Flow Cytometry
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Graft vs Host Disease / diagnosis
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Granulocyte-Macrophage Colony-Stimulating Factor / pharmacology
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HLA Antigens / immunology
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Hematopoietic Stem Cell Transplantation / adverse effects
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Hematopoietic Stem Cell Transplantation / methods*
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Humans
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Interleukin-4 / pharmacology
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Lymphocyte Activation / immunology
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Lymphocyte Count
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Lymphocytes / immunology
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Male
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Middle Aged
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Monocytes / drug effects
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Monocytes / immunology
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Patient Selection
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Phosphoproteins / immunology
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Receptors, Antigen, T-Cell, alpha-beta / immunology
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T-Lymphocyte Subsets / immunology
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T-Lymphocytes / drug effects
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T-Lymphocytes / immunology
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T-Lymphocytes / transplantation*
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Transplantation Conditioning
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Treatment Outcome
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Viral Matrix Proteins / immunology
Substances
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Antigens, Viral
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Antiviral Agents
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Complementarity Determining Regions
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DNA, Viral
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HLA Antigens
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Phosphoproteins
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Receptors, Antigen, T-Cell, alpha-beta
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Viral Matrix Proteins
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cytomegalovirus matrix protein 65kDa
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Interleukin-4
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Granulocyte-Macrophage Colony-Stimulating Factor
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Cyclosporine