Lea Graafen, C. Speckmann, Shahrzad Bakhtiar, Horst von Bernuth, Kai Lehmberg, Peter Bader, Ulrich Baumann, Rita Beier, Stephan Borte, Inken Brockow, E. Graham Davies, Maximilian Hartmann, Ursula Holzer, Christian Klemann, Alexandra Y. Kreins, Renate Krüger, Udo Kontny, Hans‐Jürgen Laws, Andrea Meinhardt, H. Morbach, Nora Naumann-Bartsch, Tobias Rothoeft, Dominik T. Schneider, André Willasch, Austen Worth, Markus G. Seidel, Michael H. Albert, Stephan Ehl, Fabian Hauck, Manfred Hönig, Ansgar Schulz, Catharina Schuetz, Sujal Ghosh
TREC-NBS identifies patients with inborn errors of immunity (IEI) and syndromic features, but uncertainty remains regarding their immunological management. To address this, syndromic patients detected by TREC-NBS in Germany between August 2019 and April 2024 were systematically analyzed, including phenotype, treatment, and outcomes. National registries were screened, and data were completed by the treating centres. A total of 77 syndromic patients were identified, with 22 different gene defects found in 72 individuals (93.5%). Primary thymic deficiency was present in 64% (49/77), most commonly due to 22q11.2 deletion syndrome (62%). Common clinical features included congenital heart disease (57%), facial/skeletal abnormalities (53%), and neurological symptoms (36%). Definitive treatments were provided promptly in eligible patients, including 6 thymus transplants and 6 hematopoietic stem cell transplants (HSCT). A watch-and-wait approach was applied to the remaining patients, with 34% (22/65) receiving prophylactic treatment. Recovery of CD3 + T-cell counts was limited to a minority. Overall survival was 89%, with a median follow-up of 32 months (range 0.5-60). To conclude, this is the first comprehensive study of syndromic IEI patients identified through TREC-NBS. The findings show that the German healthcare system enables both early prophylactic care and timely access to definitive therapies. Moving forward, interdisciplinary collaboration will be key to developing evidence-based management guidelines for this challenging patient group.