Immunological monitoring during and following OKT3 therapy in children

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Abstract
Immunologic monitoring during and following OKT3 monoclonal antibody therapy provides insight into the efficacy of the drug in treating or preventing allograft rejection. Depletion of CD3 + lymphocytes occurred following the first dose in all children treated with OKT3. There was a continued modulation of CD3+ lymphocytes throughout OKT3 therapy. Pre‐OKT3 treatment lymphocyte subsets were higher in younger children than in older children, and higher than previously reported in adults. Trough serum OKT3 concentrations were higher in children being treated for rejection than has been seen in adults. Pediatric transplant patients receiving OKT3 prophylactically had a trend towards lower drug concentrations as therapy progressed, while children being retreated with OKT3 had lower drug levels at the initiation of therapy that required increases in their daily OKT3 dose. Formation of OKT3 antibodies was 33%, which is similar to what we have reported in adults. A large number of pediatric liver recipients required increases in their daily OKT3 dose in order to achieve depletion of CD3+ cells (< 25/mm3) and ensure therapeutic OKT3 serum concentrations (> 800 ng/ml). In conclusion, immunologic monitoring during and following OKT3 therapy in children is necessary to ensure that the drug is being used most effectively and to determine if retreatment is possible.