Prospective cohort study of immunosuppression taper and discontinuation after allogeneic stem cell transplantation

作者：Abu‐Sayeef Mirza, Jongphil Kim, R. S. Thapa, Claudio Anasetti, Nelli Bejanyan, Omar Castaneda, Rawan Faramand, Nima Ghalehsari, Doris K. Hansen, Michael D. Jain, Farhad Khimani, Aleksandr Lazaryan, Hien Liu, Frederick Locke, Asmita Mishra, Michael Nieder, Taiga Nishihori, L. Perez, Fabiana Perna, Reshma Ramlal, Nancy Torres Luna, Conor Loy, Iwijn De Vlaminck, Leslie Kean, Joseph Pidala · 发表于：Blood Immunology & Cellular Therapy · 年份：2026 · DOI：10.1016/j.bict.2026.100057 · 研究领域：Hematopoietic Stem Cell Transplantation、T-cell and B-cell Immunology、CAR-T cell therapy research

Patients tapering and discontinuing immune suppression (IS) often develop graft vs. host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT). We prospectively enrolled HCT patients at relevant time points of initiation of taper of last systemic IS agent (cohort 1) or at time of complete IS stop (cohort 2) to identify rates and determinants of failure. Actual IS taper practice was recorded, and patients were followed for scheduled and event-driven clinical data and research blood samples. Success was defined as complete discontinuation of IS and durable freedom from GVHD; failure as GVHD during/after taper (cohort 1), or after IS stop (cohort 2). Median follow-up post-HCT was 53 months (range 10–141). Cohort 1 enrolled at median 15.6 months post-HCT. Failure during IS taper occurred in 43% (60% total considering failure during IS taper and after IS stop). Median time to failure was 8.3 months (range 1.1–39.5), manifesting as acute (26%) or chronic (74%) GVHD. Cohort 2 enrolled at median of 25 months post-HCT. Subsequent failure occurred in 44% at median of 4.5 months (range 0.1-27.1) manifesting as acute GVHD (20%) or chronic GVHD (80%). This prospective cohort study provides new insight into GVHD risk during IS taper/discontinuation and establishes a biologic sample repository for investigation into immune tolerance.