Haploidentical T-cell alpha beta receptor and CD19–depleted stem cell transplant for Wiskott-Aldrich syndrome

The use of HLA-haploidentical family donors requires T-cell depletion to avoid graft-versus-host disease (GVHD), which increases the risk of graft rejection, particularly for patients with forms of primary immunodeficiency other than severe combined immune deficiency.3 Various T-cell depletion strategies have been used to minimize GVHD and maximize sustained engraftment and early immune reconstitution, such as enrichment of CD34+ cells or depletion of CD3+ and CD19+ cells to prevent post-transplant lymphoproliferative disorder. The drawback of positive CD34+ selection is that a large number of effector cells, such as natural killer (NK), myeloid, and plasmacytoid dendritic cells--which aid engraftment and also decrease the risk of infection--are lost.