Genotype, oxidase status, and preceding infection or autoinflammation do not affect allogeneic HCT outcomes for CGD
Authors: Leiding Jennifer W. , Arnold Danielle E. , Parikh Suhag , Logan Brent , Marsh Rebecca A. , Griffith Linda M. , Wu Ruizhe , Kidd Sharon , Mallhi Kanwaldeep , Chellapandian Deepak , Si Lim Stephanie J. , Grunebaum Eyal , Falcone E. Liana , Murguia-Favela Luis , Grossman Debbi , Prasad Vinod K. , Heimall Jennifer R. , Touzot Fabien , Burroughs Lauri M. , Bleesing Jack , Kapoor Neena , Dara Jasmeen , Williams Olatundun , Kapadia Malika , Oshrine Benjamin R. , Bednarski Jeffrey J. , Rayes Ahmad , Chong Hey , Cuvelier Geoffrey D. E. , Forbes Satter Lisa R. , Martinez Caridad , Vander Lugt Mark T. , Yu Lolie C. , Chandrakasan Shanmuganathan , Joshi Avni , Prockop Susan E. , Dávila Saldaña Blachy J. , Aquino Victor , Broglie Larisa A. , Ebens Christen L. , Madden Lisa M. , DeSantes Kenneth , Milner Jordan , Rangarajan Hemalatha G. , Shah Ami J. , Gillio Alfred P. , Knutsen Alan P. , Miller Holly K. , Moore Theodore B. , Graham Pamela , Bauchat Andrea , Bunin Nancy J. , Teira Pierre , Petrovic Aleksandra , Chandra Sharat , Abdel-Azim Hisham , Dorsey Morna J. , Birbrayer Olga , Cowan Morton J. , Dvorak Christopher C. , Haddad Elie , Kohn Donald B. , Notarangelo Luigi D. , Pai Sung-Yun , Puck Jennifer M. , Pulsipher Michael A. , Torgerson Troy R. , Malech Harry L. , Kang Elizabeth M. 
Published: August 2023

Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by life-threatening infections and inflammatory conditions. Hematopoietic cell transplantation (HCT) is the definitive treatment for CGD, but questions remain regarding patient selection and impact of active disease on transplant outcomes. We performed a multi-institutional retrospective and prospective study of 391 patients with CGD treated either conventionally (non-HCT) enrolled from 2004 to 2018 or with HCT from 1996 to 2018. Median follow-up after HCT was 3.7 years with a 3-year overall survival of 82% and event-free survival of 69%. In a multivariate analysis, a Lansky/Karnofsky score &lt;90 and use of HLA-mismatched donors negatively affected survival. Age, genotype, and oxidase status did not affect outcomes. Before HCT, patients had higher infection density, higher frequency of noninfectious lung and liver diseases, and more steroid use than conventionally treated patients; however, these issues did not adversely affect HCT survival. Presence of pre-HCT inflammatory conditions was associated with chronic graft-versus-host disease. Graft failure or receipt of a second HCT occurred in 17.6% of the patients and was associated with melphalan-based conditioning and/or early mixed chimerism. At 3 to 5 years after HCT, patients had improved growth and nutrition, resolved infections and inflammatory disease, and lower rates of antimicrobial prophylaxis or corticosteroid use compared with both their baseline and those of conventionally treated patients. HCT leads to durable resolution of CGD symptoms and lowers the burden of the disease. Patients with active infection or inflammation are candidates for transplants; HCT should be considered before the development of comorbidities that could affect performance status. This trial was registered at www.clinicaltrials.gov as #NCT02082353.