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Blood, 15 May 2007, Vol. 109, No. 10, pp. 4575-4581.
Prepublished online as a Blood First Edition Paper on February 1, 2007; DOI 10.1182/blood-2006-07-029090.
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TRANSPLANTATION
Long-term T-cell reconstitution after hematopoietic stem-cell transplantation in primary T-cellimmunodeficient patients is associated with myeloid chimerism and possibly the primary disease phenotype
Marina Cavazzana-Calvo1,2,
Frédérique Carlier2,
Françoise Le Deist3,
Estelle Morillon1,
Pierre Taupin4,
David Gautier5,
Isabelle Radford-Weiss6,
Sophie Caillat-Zucman7,
Bénédicte Neven8,
Stephane Blanche8,
Rémi Cheynier5,
Alain Fischer1,8, and
Salima Hacein-Bey-Abina1,2
1 Institut National de la Santé et de la Recherche Médicale (INSERM), Unité (U) 768, Paris, France; Université René Descartes, Paris, France; Hôpital NeckerEnfants Malades, Paris, France;
2 Département de Biothérapies, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital NeckerEnfants Malades, Paris, France;
3 Centre d'Etude des Déficits Immunitaires, Hôpital NeckerEnfants Malades, Paris, France;
4 Département de BiostatistiqueHôpital NeckerEnfants Malades, Paris, France;
5 Unité des Virus Lents, Institut Pasteur, Paris;
6 Laboratoire de cytogénétique, Hôpital NeckerEnfants Malades, Paris, France;
7 Laboratoire d'Immunologie, Hôpital NeckerEnfants Malades, Paris, France;
8 Unité d'Immunologie et Hématologie Pédiatrique, Hôpital NeckerEnfants Malades, Paris, France
We studied T-cell reconstitution in 31 primary T-cellimmunodeficient patients who had undergone hematopoietic stem-cell transplantation (HSCT) over 10 years previously. In 19 patients, there was no evidence of myeloid chimerism because little or no myeloablation had been performed. Given this context, we sought factors associated with good long-term T-cell reconstitution. We found that all patients having undergone full myeloablation had donor myeloid cells and persistent thymopoiesis, as evidenced by the presence of naive T cells carrying T-cell receptor excision circles (TRECs). In 9 patients with host myeloid chimerism, sustained thymic output was also observed and appeared to be associated with c deficiency. It is therefore possible that the complete absence of thymic progenitors characterizing this condition created a more favorable environment for thymic seeding by a population of early progenitor cells with the potential for self-renewal, thus enabling long-term (> 10 years) T-cell production.

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