Prolonged immune deficiency following allogeneic stem cell transplantation: risk factors and complications in adult patients
| Autor: | S, Maury, J Y, Mary, C, Rabian, M, Schwarzinger, A, Toubert, C, Scieux, M, Carmagnat, H, Esperou, P, Ribaud, A, Devergie, P, Guardiola, P, Vexiau, D, Charron, E, Gluckman, G, Socié |
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| Rok vydání: | 2001 |
| Předmět: |
Adult
CD4-Positive T-Lymphocytes Male Adolescent Graft vs Host Disease CD8-Positive T-Lymphocytes Lymphocyte Activation Tetanus Toxin Risk Factors Azathioprine Humans Transplantation Homologous Lymphocyte Count Prospective Studies Glucocorticoids B-Lymphocytes Leukemia Hematopoietic Stem Cell Transplantation Middle Aged Killer Cells Natural Cytomegalovirus Infections Multivariate Analysis Cyclosporine Drug Therapy Combination Female Immunosuppressive Agents Follow-Up Studies |
| Zdroj: | British journal of haematology. 115(3) |
| ISSN: | 0007-1048 |
| Popis: | To evaluate the long-term immune reconstitution after allogeneic haematopoietic stem cell transplantation (SCT), we prospectively screened standard immune parameters in a series of 105 patients, at a median time of 15 months after SCT. Analysing lymphoid phenotypes, in vitro immune functions and immunoglobulin levels, we found that, more than 1 year post SCT, cellular and humoral immunity was still altered in a significant number of patients. CD4+ T cells were200/microl in one third of patients, and the CD4/CD8 ratio was still reversed in 78% of patients. Almost all patients showed positive T-cell responses against mitogens, but antigen-specific proliferation assays identified 20% to 80% of non-responders. B-cell counts were reconstituted in 61% of the patients, but levels of total immunoglobulins were still low in 59%. In multivariate analyses, human leucocyte antigen (HLA) disparity between donor and recipient and chronic graft-versus-host disease were the leading causes affecting immune reconstitution. Interestingly, cytomegalovirus (CMV) infections were strongly associated with normal CD8+ T-cell counts. Studying the impact of impaired immune reconstitution on the rate of infections occurring in the 6 years following screening, we identified three parameters (low B-cell count, inverted CD4/CD8 ratio, and negative response to tetanus toxin) as significant risk factors for developing such late infections. |
| Databáze: | OpenAIRE |
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