Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Mar 7:16:1519955.
doi: 10.3389/fimmu.2025.1519955. eCollection 2025.

Multidisciplinary approach to treating complex immune dysregulation disorders: an adaptive model for institutional implementation

Lauren A Henderson  1 , Roshini S Abraham  2 , Aisha Ahmed  3 , Lindsey Blount  4 , Scott W Canna  5 , Natalia S Chaimowitz  6 , Shanmuganathan Chandrakasan  7 , Bria Coates  4 , James A Connelly  8 , Megan A Cooper  9 , Christine N Duncan  10 , Anthony French  11 , Melissa Hazen  12 , Michelle L Hermiston  13 , Brian Nolan  14 , Anish Ray  15 , Melissa J Rose  16 , Lisa Forbes Satter  17   18 , Grant Schulert  19 , Sara Kristen Sexson Tejtel  20 , Tiphanie Vogel  18   21 , Kelly Walkovich  22 , Matt S Zinter  23 , Edward M Behrens  5
Affiliations
Review

Multidisciplinary approach to treating complex immune dysregulation disorders: an adaptive model for institutional implementation

Lauren A Henderson et al. Front Immunol. .

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: collaborative management; hemophagocytic lymphohistiocytosis; immune dysregulation; institutional implementation; multidisciplinary teams; quality improvement research.

PubMed Disclaimer

Conflict of interest statement

LAH received salary support from CARRA; investigator-initiated research grants from BMS; and consulting fees from Sobi, Pfizer, and Adaptive Biotechnologies. RSA, AA, NSC, MAC, SC, CND, AF, MH, SKST, KW, and MSZ have nothing to disclose. LB has participated in a medical advisory board and served as a consultant for Sobi. SWC received consulting fees from Sobi. BC is funded by NHLBI and the American Lung Association. JAC has served on advisory boards for Sobi and Pharming. MLH has served on external advisory boards for Novartis and Sobi. BN has participated in a medical advisory board for Sobi. AR serves as a speaker/advisor for Sobi and BTG. MJR has served on advisory boards for Genentech and Novartis. LFS has served as a consultant for Grifols, Takeda, CSL Behring, Horizon, Sobi, and Pharming. GS has received consulting fees from Boehringer Ingelheim and research support from IpiNovyx. TV has consulted for Novartis, Sobi, Pfizer, and Moderna and receives research support from AstraZeneca. EMB has consulted for and received grant support from Sobi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare that this study received funding from Sobi, Inc. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.

Figures

Figure 1
Figure 1
Potential benefits of MDT care for different stakeholders. HCP, healthcare provider; MDT, multidisciplinary team; QI, quality improvement.
Figure 2
Figure 2
Shared elements among different immMDTs. EMR, electronic medical record; HLH, hemophagocytic lymphohistiocytosis; ICU, intensive care unit; immMDT, immune dysregulation multidisciplinary team; MAS, macrophage activation syndrome; MDT, multidisciplinary team.
Figure 3
Figure 3
Descriptive model of the typical immMDT. EMR, electronic medical record; immMDT, immune dysregulation multidisciplinary team; MDT, multidisciplinary team; QI, quality improvement.
Figure 4
Figure 4
Core aspects needed to establish a context-dependent immMDT. The most essential features required for a successful immMDT are listed in the center of the circle. immMDT, immune dysregulation multidisciplinary team; MDT, multidisciplinary team; QI, quality improvement.
See this image and copyright information in PMC

References

    1. Chan AY, Torgerson TR. Primary immune regulatory disorders: a growing universe of immune dysregulation. Curr Opin Allergy Clin Immunol. (2020) 20:582–90. doi: 10.1097/ACI.0000000000000689 - DOI - PMC - PubMed
    1. Flinn AM, Gennery AR. Primary immune regulatory disorders: Undiagnosed needles in the haystack? Orphanet J Rare Dis. (2022) 17:99. doi: 10.1186/s13023-022-02249-1 - DOI - PMC - PubMed
    1. Long A, Kleiner A, Looney RJ. Immune dysregulation. J Allergy Clin Immunol. (2023) 151:70–80. doi: 10.1016/j.jaci.2022.11.001 - DOI - PubMed
    1. Chan AY, Leiding JW, Liu X, Logan BR, Burroughs LM, Allenspach EJ, et al. . Hematopoietic cell transplantation in patients with primary immune regulatory disorders (PIRD): A primary immune deficiency treatment consortium (PIDTC) survey. Front Immunol. (2020) 11:239. doi: 10.3389/fimmu.2020.00239 - DOI - PMC - PubMed
    1. Swigart LR, Sanchez-Pinto LN, Nolan BE, Seed PC, Coates BM. A specialized multi-disciplinary care program for children with sepsis and multiple organ dysfunction-associated immune dysregulation. Pediatr Res. (2022) 91:464–9. doi: 10.1038/s41390-021-01891-y - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources