Stem cell transplantation for autoimmune disorders. Immune reconstitution

Lymphocyte recovery is delayed following autologous haematopoietic stem cell transplantation (HSCT). B-cells recover before T-cells and CD8+ before CD4+ T-cells. The initial phase of T-cell recovery is dependent upon the expansion of mature host T-cells that have survived conditioning or are transferred back with the graft. This phase is therefore quicker when the graft is not CD34+ selected. Subsequently, naïve T-cells appear. Naïve CD4+ T-cell recovery is thymus dependent and starts at around 6-9 months. Naïve CD8+ recovery occurs earlier and seems less thymus dependent. Immune function recovers later than lymphocyte number, the former being dependent on a broad repertoire and diversity of effector function. We currently do not know which reconstitution markers are more likely to predict prolonged disease remission as opposed to relapse. Similarly, it is unclear whether disease-specific factors influence reconstitution. A continued, close collaboration between scientists and physicians should both improve the outcomes of HSCT and also provide important pathogenic information about the diseases under treatment.