Comparison of immune reconstitution after unrelated and related T-cell-depleted bone marrow transplantation: Effect of patient age and donor leukocyte infusions Journal Article


Authors: Small, T. N.; Papadopoulos, E. B.; Boulad, F.; Black, P.; Castro-Malaspina, H.; Childs, B. H.; Collins, N.; Gillio, A.; George, D.; Jakubowski, A.; Heller, G.; Fazzari, M.; Kernan, N.; MacKinnon, S.; Szabolcs, P.; Young, J. W.; O'Reilly, R. J.
Article Title: Comparison of immune reconstitution after unrelated and related T-cell-depleted bone marrow transplantation: Effect of patient age and donor leukocyte infusions
Abstract: Unrelated bone marrow transplantation (BMT) is often complicated by fatal opportunistic infections. To evaluate features unique to immune reconstitution after unrelated BMT, the lymphoid phenotype, in vitro function, and life-threatening opportunistic infections after unrelated and related T-cell-depleted (TCD) BMT were analyzed longitudinally and compared. The effects of posttransplant donor leukocyte infusions to treat or prevent cytomegalovirus (CMV) or Epstein-Barr virus (EBV) infections on immune reconstitution were also analyzed. This study demonstrates that adult recipients of TCD unrelated BMTs experience prolonged and profound deficiencies of CD3+, CD4+, and CD8+ T-cell populations when compared with pediatric recipients of unrelated BMT and adults after related BMT (P < .01), that these adults have a significantly increased risk of life-threatening opportunistic infections, and that the rate of recovery of CD4 T cells correlates with the risk of developing these infections. Recovery of normal numbers of CD3+, CD8+, and CD4+ T-cell populations is similar in children after related or unrelated BMT. This study also demonstrates that adoptive immunotherapy with small numbers of unirradiated donor leukocytes can be associated with rapid restoration of CD3+, CD4+, and CD8+ T-cell numbers, antigen-specific T-cell responses, and resolution of CMV- and EBV-associated disease after unrelated TCD BMT.
Keywords: adolescent; adult; child; aged; child, preschool; middle aged; leukemia; major clinical study; follow up; t-lymphocytes; multiple myeloma; cyclophosphamide; myelodysplastic syndrome; whole body radiation; graft versus host reaction; postoperative infection; adoptive transfer; aging; methylprednisolone; preoperative treatment; immunosuppressive treatment; bone marrow transplantation; ganciclovir; cytomegalovirus infection; immunotherapy, adoptive; infection risk; lymphocyte depletion; infection sensitivity; lymphocyte count; opportunistic infections; thymocyte antibody; aplastic anemia; opportunistic infection; epstein-barr virus infections; cytomegalovirus infections; infectious mononucleosis; leukocyte transfusion; humans; human; male; female; priority journal; article
Journal Title: Blood
Volume: 93
Issue: 2
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 1999-01-15
Start Page: 467
End Page: 480
Language: English
PUBMED: 9885208
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus