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Blood, 1 June 2001, Vol. 97, No. 11, pp. 3380-3389
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Immune reconstitution after allogeneic marrow transplantation
compared with blood stem cell transplantation
Jan Storek,
Monja A. Dawson,
Barry Storer,
Terry Stevens-Ayers,
David G. Maloney,
Kieren A. Marr,
Robert P. Witherspoon,
William Bensinger,
Mary E. D. Flowers,
Paul Martin,
Rainer Storb,
Frederick R. Appelbaum, and
Michael Boeckh
From the Fred Hutchinson Cancer Research Center and
University of Washington, Seattle, WA.
Allogeneic peripheral blood stem cell grafts contain about 10 times more T and B cells than marrow grafts. Because these cells may
survive in transplant recipients for a long time, recipients of blood
stem cells may be less immunocompromised than recipients of marrow.
Immune reconstitution was studied in 115 patients randomly assigned to
receive either allogeneic marrow or filgrastim-mobilized blood stem
cell transplantation. Between day 30 and 365 after transplantation,
counts of most lymphocyte subsets were higher in the blood stem cell
recipients. The difference was most striking for CD4 T cells (about
4-fold higher counts for CD45RAhigh CD4 T cells and about
2-fold higher counts for CD45RAlow/ CD4 T cells;
P < .05). On assessment using phytohemagglutinin and
herpesvirus antigen-stimulated proliferation, T cells in the 2 groups
of patients appeared equally functional. Median serum IgG levels were
similar in the 2 groups. The rate of definite infections after
engraftment was 1.7-fold higher in marrow recipients (P = .001). The rate of severe (inpatient treatment
required) definite infections after engraftment was 2.4-fold higher in
marrow recipients (P = .002). The difference in the rates
of definite infections was greatest for fungal infections, intermediate
for bacterial infections, and lowest for viral infections. Death
associated with a fungal or bacterial infection occurred between day 30 and day 365 after transplantation in 9 marrow recipients and no blood stem cell recipients (P = .008). In conclusion, blood
stem cell recipients have higher lymphocyte-subset counts and this
appears to result in fewer infections.
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