TCRαβ-depleted hematopoietic stem cell transplant and third-party CD45RA+ depleted adoptive cell therapy for treatment of post-transplant parvovirus B19 aplastic crisis

Abstract

Abstract This is a case report of a 6-year-old girl with relapsed B cell acute lymphoblastic leukemia in which adoptive cell therapy was successfully applied to treat refractory HPV B19 infection. Allogenic-CAR T-cell therapy (bispecific CD19/CD22) bridged to HSCT was performed using a haploidentical paternal donor. However, HPV B19 DNAemia progressed and a transfusion-related graft versus host disease occurred. After finding a third party related donor with a better HLA match haploidentical HPV B19- seropositive CD45RA+ depleted cells (16.5×106/kg) were administered and the HPV B19 DNAemia became negative within one week and reticulocyte, neutrophil, hemoglobin, and platelet counts gradually normalized. The patient remained stable during the one-year outpatient follow-up period. Our case report highlighted that persistent B19 infection can lead to pancytopenia, aplastic crisis, and graft rejection. TCRαβ+ depleted haplo-HSCT is an effective way to quickly achieve hematopoiesis recovery. CD45RO memory T cell therapy is the key to treating and preventing the development of refractory severe HPV B19 infection.