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Immune reconstitution following allogeneic peripheral blood stem cell transplants
S Shenoy1, T Mohanakumar, G Todd
1Department of Pediatric Hematology-Oncology (Division), St Louis Children's Hospital, Washington University School of Medicine, MO 63110, USA.
Bone Marrow Transplantation
|April 1, 1999
Summary
Peripheral blood stem cell transplants (PBSCT) show delayed lymphocyte recovery and impaired NK cell function in the first year. Immune reconstitution impacts graft-versus-host disease (GVHD) and infection risk post-transplant.
Area of Science:
- Hematology
- Immunology
- Transplantation Medicine
Background:
- Growth factor-mobilized peripheral blood stem cells (PBSCs) offer rapid engraftment compared to bone marrow (BM).
- However, PBSC mobilization also includes mature lymphocytes and monocytes, potentially affecting immune reconstitution and graft-versus-host disease (GVHD).
Purpose of the Study:
- To serially evaluate immune reconstitution and cytokine expression in PBSCT recipients during the first year post-transplant.
- To understand the relationship between immune recovery, GVHD, and clinical outcomes.
Main Methods:
- Serial evaluation of immune cell populations (NK, B, T cells) and their functions.
- Measurement of cytokine mRNA expression (TNF-alpha, IL-10, IL-2, IFN-gamma).
- Assessment of GVHD incidence and Cytomegalovirus (CMV) viremia.
Main Results:
- Neutrophil and monocyte engraftment stabilized early; NK, B, and CD4+ T cell counts remained low with reversed CD4:CD8 ratios.
- NK cell function was persistently low; CD4+ T cell proliferation was reduced, but qualitative functions were preserved.
- High rates of acute and chronic GVHD (37% and 72%, respectively) and CMV viremia (62%) were observed.
Conclusions:
- Lymphocyte engraftment is quantitatively delayed post-PBSCT, with compromised NK cell function but preserved CD4+ T cell qualitative functions.
- Decreased IL-10 expression after 6 months and persistent TNF-alpha expression may influence infection and GVHD.
- The balance between quantitative lymphocyte recovery and qualitative functions, along with cytokine patterns, impacts clinical outcomes in PBSCT recipients.