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T lymphocyte repopulation and differentiation after bone marrow
transplantation. Early shifts in the ratio between T4+ and T8+ T
lymphocytes correlate with the occurrence of acute graft-versus-host
disease
JW Gratama, A Naipal, P Oljans, FE Zwaan, LF Verdonck, T de Witte, JM Vossen, RL Bolhuis, GC de Gast and J Jansen
Acute graft-versus-host disease (GVHD), a major complication of allogeneic
bone marrow transplantation (BMT), is probably mediated by T lymphocytes
present in the marrow graft. In this study, the repopulation of the
peripheral blood with T4+ and T8+ T cells was investigated during the
period preceding the occurrence of acute GVHD. Twenty-four allogeneic and
11 autologous BMT recipients were monitored from day 4 post-BMT onward by
the use of monoclonal antibodies, indirect immunofluorescence, and flow
cytometry. The recipients of allogeneic transplants received methotrexate
as GVHD prophylaxis. Similar recovery patterns for T4+ and T8+ T cells were
found following autologous and allogeneic BMT. However, lymphoid
repopulation occurred at a clearly faster rate after autologous BMT. T4+ T
cells were the first to reappear in the peripheral blood, followed by T8+ T
cells 4-7 days later. The T8+ T cell reconstitution occurred at an even
faster rate in patients who were to develop grade II-IV GVHD, as compared
with those with grade O-I GVHD, thus leading to an earlier decrease in the
T4/T8 ratio. Of 10 patients with a T4/T8 ratio less than 2.5 at day 19, 9
developed grade II-IV GVHD and 1 showed no GVHD. Of 14 patients with a
ratio greater than 2.5 at that time, only 2 developed grade II-IV and 12
grade O-I GVHD (p less than 0.001). In the 11 patients developing grade
II-IV GVHD, the T4/T8 ratio decreased to values less than 2.5 before the
first clinical symptoms of GVHD in 9; it coincided in one and occurred
later in another patient. Thus, early monitoring of the T4/T8 ratio can
distinguish patients at risk of developing grade II-IV GVHD.
Volume 63,
Issue 6,
pp. 1416-1423,
06/01/1984
Copyright © 1984 by The American Society of Hematology
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