Frontiers in Immunology (Mar 2025)
Multidisciplinary approach to treating complex immune dysregulation disorders: an adaptive model for institutional implementation
- Lauren A. Henderson,
- Roshini S. Abraham,
- Aisha Ahmed,
- Lindsey Blount,
- Scott W. Canna,
- Natalia S. Chaimowitz,
- Shanmuganathan Chandrakasan,
- Bria Coates,
- James A. Connelly,
- Megan A. Cooper,
- Christine N. Duncan,
- Anthony French,
- Melissa Hazen,
- Michelle L. Hermiston,
- Brian Nolan,
- Anish Ray,
- Melissa J. Rose,
- Lisa Forbes Satter,
- Lisa Forbes Satter,
- Grant Schulert,
- Sara Kristen Sexson Tejtel,
- Tiphanie Vogel,
- Tiphanie Vogel,
- Kelly Walkovich,
- Matt S. Zinter,
- Edward M. Behrens
Affiliations
- Lauren A. Henderson
- Division of Immunology, Boston Children’s Hospital, Boston, MA, United States
- Roshini S. Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
- Aisha Ahmed
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern University, Chicago, IL, United States
- Lindsey Blount
- Division of Critical Care, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Scott W. Canna
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Division of Rheumatology, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Natalia S. Chaimowitz
- Department of Immunology, Cook Children’s Medical Center, Fort Worth, TX, United States
- Shanmuganathan Chandrakasan
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States
- Bria Coates
- Division of Critical Care, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- James A. Connelly
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Megan A. Cooper
- Division of Rheumatology and Immunology, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, United States
- Christine N. Duncan
- 0Pediatric Hematopoietic Cellular Therapy, Dana Farber/Boston Children’s Cancer and Blood Disorders Center and Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Anthony French
- 1Division of Pediatric Rheumatology/Immunology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
- Melissa Hazen
- 2Division of Immunology and Department of Pediatrics, Division of Pediatric Hospital Medicine, Boston Children’s Hospital, Boston, MA, United States
- Michelle L. Hermiston
- 3Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA, United States
- Brian Nolan
- 4Division of Rheumatology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Anish Ray
- 5Texas College of Osteopathic Medicine, The University of North Texas Health Science Center and Department of Hematology/Oncology, Cook Children’s Medical Center, Fort Worth, TX, United States
- Melissa J. Rose
- 6Division of Pediatric Hematology and Oncology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
- Lisa Forbes Satter
- 7Department of Pediatrics, Division of Immunology, Allergy, and Retrovirology, Baylor College of Medicine, Houston, TX, United States
- Lisa Forbes Satter
- 8William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, TX, United States
- Grant Schulert
- 9Division of Rheumatology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Sara Kristen Sexson Tejtel
- 0Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, United States
- Tiphanie Vogel
- 8William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, TX, United States
- Tiphanie Vogel
- 1Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
- Kelly Walkovich
- 2Pediatric Hematology/Oncology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, United States
- Matt S. Zinter
- 3Department of Pediatrics, Division of Critical Care Medicine, UCSF School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Edward M. Behrens
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Division of Rheumatology, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- DOI
- https://doi.org/10.3389/fimmu.2025.1519955
- Journal volume & issue
-
Vol. 16
Abstract
Patients with immune dysregulation may present with varying combinations of autoimmunity, autoinflammation, immunodeficiency, atopy, lymphoproliferation, and/or malignancy, often with multisystem involvement. Recognizing specific patterns of immune dysregulation, coordinating and interpreting complex diagnostic testing, and choosing initial (often empiric) treatment can be challenging. Centers are increasingly assembling multidisciplinary teams (MDTs) to standardize evaluation and optimize treatment of patients with complex immune dysregulation (immune dysregulation MDTs [immMDTs]). However, published information on the composition and function of immMDTs is sparse, and there is little guidance for those seeking to establish or optimize an immMDT. To inform this review, we assembled a panel of 24 pediatric providers from multiple specialties who actively participate in immMDTs to provide expert opinion. We also conducted a search of the available information on pediatric immMDTs from PubMed. Based on these insights, we summarize the structure and function of active immMDTs across the United States and focus on best practices and context-dependent solutions that may enable institutions with varying goals, patient populations, and resources to establish an immMDT.
Keywords
- multidisciplinary teams
- collaborative management
- immune dysregulation
- institutional implementation
- quality improvement research
- hemophagocytic lymphohistiocytosis
