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Here we describe a unique and severe adverse event of VST therapy in an infant with severe combined immunodeficiency, who receives, as part of a clinical trial (NCT03475212), third party VSTs for treating cytomegalovirus viremia following bone marrow transplantation. At one-month post-VST infusion, rejection of graft and reversal of chimerism is observed, as is an expansion of T cells exclusively from the VST donor. Single-cell gene expression and T cell receptor profiling demonstrate a narrow repertoire of predominantly activated CD4<jats:sup>+<\/jats:sup> T cells in the recipient at the time of rejection, with the repertoire overlapping more with that of peripheral blood from VST donor than the infused VST product. This case thus demonstrates a rare but serious side effect of VST therapy.<\/jats:p>","DOI":"10.1038\/s41467-024-47056-3","type":"journal-article","created":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T10:01:53Z","timestamp":1711706513000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Secondary bone marrow graft loss after third-party virus-specific T cell infusion: Case report of a rare complication"],"prefix":"10.1038","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8323-3085","authenticated-orcid":false,"given":"Michael D.","family":"Keller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6860-5079","authenticated-orcid":false,"given":"Stefan A.","family":"Schattgen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8007-9932","authenticated-orcid":false,"given":"Shanmuganathan","family":"Chandrakasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3067-751X","authenticated-orcid":false,"given":"E. 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MAP is on Advisory boards\u2014Novartis, Gentibio, Bluebird, Vertex, Medexus, Equillium; and Study Support\u2014Adaptive, Miltenyi. PJH is a Co-founder and Board of Directors: Mana Therapeutics; and Scientific Advisory Board: Cellevolve, Cellenkos, Capsida, MicrofluidX, Discovery Life Sciences. MDK is an author for Elsevier (Uptodate), and has received research funding from Chiesi Pharmaceuticals. SC is on SAB\/ Honoraria from SOBI, honoraria from Pharming P.G.T. has consulted and\/or received honoraria and travel support from Illumina, Johnson and Johnson, and 10X Genomics. P.G.T. serves on the Scientific Advisory Board of Immunoscape and Cytoagents. The remaining authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2749"}}