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Analysis of immune reconstitution in children undergoing cord blood transplantation
A Moretta1, R Maccario, F Fagioli
1Department of Pediatrics, University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy.
Insights
Cord blood transplantation (CBT) and bone marrow transplantation (BMT) show comparable immune recovery in children. CBT recipients experienced faster B-cell recovery and reduced graft-versus-host disease (GVHD), suggesting potential advantages.
Area of Science:
- Immunology
- Hematology
- Transplantation Science
Background:
- Immune reconstitution is critical for post-transplant outcomes.
- Comparing immune recovery after cord blood transplantation (CBT) and bone marrow transplantation (BMT) is essential for optimizing pediatric hematopoietic stem cell therapies.
Purpose of the Study:
- To investigate and compare immune reconstitution in pediatric allogeneic cord blood transplantation (CBT) and bone marrow transplantation (BMT) recipients.
- To analyze the recovery of T-, B-, and NK-lymphocyte subsets, proliferative responses, and cytotoxic activities post-transplant.
Main Methods:
- Study included 23 children undergoing CBT (sibling or unrelated donors) and 23 matched BMT recipients.
- Immune cell subsets, in vitro proliferative responses to mitogens, and cytotoxic activities were assessed at 2-3 and 12-15 months post-transplant.
Main Results:
- CBT recipients demonstrated significantly higher B-lymphocyte counts compared to BMT recipients (p < 0.001).
- Recovery of T-cell subsets (CD3+, CD8+, CD4+) and proliferative responses occurred over time, irrespective of stem cell source.
- Unrelated CBT recipients showed improved CD4+ T-cell recovery (p < 0.01), and CBT recipients with acute GVHD had greater CD4+ CD45RA+ T-cell production (p < 0.005).
- Natural killer (NK) cell recovery and innate cytotoxic functions were rapid in both CBT and BMT groups.
Conclusions:
- Immune recovery in CBT recipients was rapid and comparable to BMT, despite lower lymphocyte counts in the graft.
- Reduced incidence and severity of graft-versus-host disease (GVHD) in CBT may contribute to faster immune reconstitution.
- CBT presents a viable alternative for pediatric stem cell transplantation with promising immune recovery profiles.
Objective:
The aim of this study was to investigate and compare immune reconstitution in allogeneic cord blood transplantation (CBT) and bone marrow transplantation (BMT) recipients.
Materials And Methods:
Twenty-three children underwent CBT from either human leukocyte antigen-identical siblings (11 cases) or unrelated donors (12 cases) were enrolled in the study, together with 23 matched children receiving BMT. Patients were analyzed 2-3 and 12-15 months after transplant. Recovery of T-, B-, and NK-lymphocyte subsets, proliferative in vitro response to mitogens, as well as cytotoxic activities, were investigated.
Results:
CBT recipients showed a marked increase in the number of B lymphocytes as compared with patients who underwent BMT (p < 0.001). The absolute number of CD3(+) and CD8(+) T cells, as well as the proliferative response to T-cell mitogens, recovered with time after transplantation, irrespective of the source of stem cells used. Recipients of unrelated CBT had a better recovery of CD4(+) T lymphocytes (p < 0.01). Among patients experiencing acute graft-versus-host disease (GVHD), children given CBT had a much greater production of CD4(+) CD45RA(+) T cells than BMT recipients (p < 0.005). Recovery of NK cell number and innate cytotoxic activities was fast, irrespective of the source of stem cells used.
Conclusions:
Despite the much lower number of lymphocytes transferred with the graft, recovery of lymphocyte number and function toward normal in CBT recipients was rapid and comparable to that observed after transplantation of bone marrow progenitors. This prompt immune recovery possibly was favored by the reduced incidence and severity of GVHD observed in children who underwent CBT.