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The kinetics of immune reconstitution after human marrow transplantation
LG Lum
Human marrow transplantation for the treatment of malignant and
nonmalignant disorders is becoming an established modality of therapy. As
in any aggressive therapeutic modality, the benefits must be balanced with
the risks of the therapy. The aggressive chemoradiotherapy used to prepare
patients for marrow transplantation creates a transient immunodeficiency
disorder postgrafting until the transferred donor marrow reestablishes a
competent immune system. Immune reconstitution posttransplant follows a
general pattern developing from immature to mature immune functions. Immune
reactivity during the first month postgrafting is extremely low. Cytotoxic
and phagocytic functions recover by day 100, while more specialized and
cooperative functions of T and B cells remain impaired up to one year or
more postgrafting. After the first year postgrafting, the various
components of the immune systems of most healthy marrow recipients begin to
work synchronously, whereas the immune systems of recipients with chronic
graft-v-host disease (GVHD) remain crippled. Recent evidence shows that
transfer of specific immunity from marrow donors to marrow recipients plays
a role in reestablishing immunocompetence. Transferred antigen-specific
immunity may explain why more recipients do not die from overwhelming
infections.
Volume 69,
Issue 2,
pp. 369-380,
02/01/1987
Copyright © 1987 by The American Society of Hematology
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