Klinik für Innere Medizin IHämatologie, Onkologie und Stammzelltransplantation

Immunological reconstitution after cellular therapy and secondary immunodeficiency (SID)

In hematology and oncology in general the increasing number of new targeted therapies, e.g. tyrosine kinase inhibitors, checkpoint inhibitors (anti-PD1/PDL1) confer a significant therapeutic benefit to many patients but also lead to an increase of secondary immunodeficiency (SID) contributing to morbidity and mortality of patients. After cellular therapies (allo-/auto-HCT, CAR-T cell therapy) immunological reconstitution depends on a multitude of factors (e.g. conditioning regimen, T cell depleting therapy, graft source, recipient and donor age, occurrence of GvHD). To ensure an adequate and timely immunological reconstitution is of importance both for control of infections but also recurrence of the primary disease in case of allogeneic hematopoietic cell transplantation (allo-HCT). The indication of immunoglobulin substitution in SID is largely dependent on older studies. In our group we evaluate the susceptibility to infections in these patients and dissect factors influencing immunological reconstitution and the response to vaccinations. 

Chronic GvHD (chronic graft-versus-host disease)

Chronic graft-versus-host disease (cGvHD) has a high morbidity and mortality and can affect a variety of organs.  Common symptoms of cGvHD include skin lesions, sicca of the eyes and/or mouth, diarrhea, and cholestatic liver involvement. Less prevalent manifestations are fasciitis and/or muscle involvement, esophageal motility disorders and strictures, or pulmonary cGvHD. The kidney is also postulated to be a target organ of cGvHD. We aim to better understand the pathophysiology of lung GvHD and to dissect factors influencing chronic kidney disease after allo-HCT.

Inborn errors of immunity

In adulthood predominantly antibody deficiencies (PAD) are most frequent and immunoglobulin substitution is a mainstay of therapy. Combined immunodeficiencies in adults confer a high morbidity and mortality. In pediatrics allo-HCT is established as treatment for many inborn errors of immunity. In adults with combined immunodeficiencies innovative treatment concepts are needed and the significance of allo-HCT is increasingly recognized. We participate in international multicenter trials to evaluate the significance of allo-HCT in these patients.

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