%0 Case Reports
%T Secondary bone marrow graft loss after third-party virus-specific T cell infusion: Case report of a rare complication.
%A Keller MD
%A Schattgen SA
%A Chandrakasan S
%A Allen EK
%A Jensen-Wachspress MA
%A Lazarski CA
%A Qayed M
%A Lang H
%A Hanley PJ
%A Tanna J
%A Pai SY
%A Parikh S
%A Berger SI
%A Gottschalk S
%A Pulsipher MA
%A Thomas PG
%A Bollard CM
%J Nat Commun
%V 15
%N 1
%D 2024 Mar 29
%M 38553461
%F 17.694
%R 10.1038/s41467-024-47056-3
%X Virus-specific T cells (VST) from partially-HLA matched donors have been effective for treatment of refractory viral infections in immunocompromised patients in prior studies with a good safety profile, but rare adverse events have been described. Here we describe a unique and severe adverse event of VST therapy in an infant with severe combined immunodeficiency, who receives, as part of a clinical trial (NCT03475212), third party VSTs for treating cytomegalovirus viremia following bone marrow transplantation. At one-month post-VST infusion, rejection of graft and reversal of chimerism is observed, as is an expansion of T cells exclusively from the VST donor. Single-cell gene expression and T cell receptor profiling demonstrate a narrow repertoire of predominantly activated CD4+ T cells in the recipient at the time of rejection, with the repertoire overlapping more with that of peripheral blood from VST donor than the infused VST product. This case thus demonstrates a rare but serious side effect of VST therapy.