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Immunity of patients surviving 20 to 30 years after allogeneic or syngeneic bone marrow transplantation.

Abstract：

:The duration of immunodeficiency following marrow transplantation is not known. Questionnaires were used to study the infection rates in 72 patients surviving 20 to 30 years after marrow grafting. Furthermore, in 33 of the 72 patients and in 16 donors (siblings who originally donated the marrow) leukocyte subsets were assessed by flow cytometry. T-cell receptor excision circles (TRECs), markers of T cells generated de novo, were quantitated by real-time polymerase chain reaction. Immunoglobulin G(2) (IgG(2)) and antigen-specific IgG levels were determined by enzyme-linked immunosorbent assay. Infections diagnosed more than [corrected] 15 years after transplantation occurred rarely. The average rate was 0.07 infections per patient-year (one infection every 14 years), excluding respiratory tract infections, gastroenteritis, lip sores, and hepatitis C. The counts of circulating monocytes, natural killer cells, B cells, CD4 T cells, and CD8 T cells in the patients were not lower than in the donors. The counts of TREC(+) CD4 T cells in transplant recipients younger than age 18 years (at the time of transplantation) were not different from the counts in their donors. In contrast, the counts of TREC(+) CD4 T cells were lower in transplant recipients age 18 years or older, even in those with no history of clinical extensive chronic graft-versus-host disease, compared with their donors. The levels of total IgG(2) and specific IgG against Haemophilus influenzae and Streptococcus pneumoniae were similar in patients and donors. Overall, the immunity of patients surviving 20 to 30 years after transplantation is normal or near normal. Patients who received transplants in adulthood have a clinically insignificant deficiency of de novo-generated CD4 T cells, suggesting that in these patients the posttransplantation thymic insufficiency may not be fully reversible.

journal_name

Blood

journal_title

Blood

authors

Storek J,Joseph A,Espino G,Dawson MA,Douek DC,Sullivan KM,Flowers ME,Martin P,Mathioudakis G,Nash RA,Storb R,Appelbaum FR,Maloney DG

doi

10.1182/blood.v98.13.3505

subject

Has Abstract

pub_date

2001-12-15 00:00:00

pages

3505-12

issue

eissn

0006-4971

issn

1528-0020

journal_volume

pub_type

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Immunity of patients surviving 20 to 30 years after allogeneic or syngeneic bone marrow transplantation.