Infectious morbidity in long-term survivors of allogeneic marrow transplantation is associated with low CD4 T cell counts.
Survivors of allogeneic marrow transplants are immunodeficient for at least 1 year after grafting. Multiple defects of immunity have been found; however, it is not known which defect primarily accounts for the high infectious morbidity of these patients. Twenty-nine allograft recipients who were in complete remission of the original disease were examined for the following parameters of immunity at 1 year after transplant: infection score (gauging the number and severity of infections within the 6 months prior to the annual exam), serum total IgM, IgG, and IgA, anti-Haemophilus influenzae IgG, anti-Streptococcus pneumoniae IgG, skin test reactivity, and the blood counts of B cells, CD4+ T cells, CD8+ T cells, and their subsets. THe only parameter inversely correlated with the infection score was CD4+ T cell count (P = 0.005 in univariable analysis, P = 0.06 in multivariable analysis). We conclude that infectious morbidity of long-term transplant survivors is related to the reconstitution of CD4+ T cells.
Storek
J
J
Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle 98104-2092, USA.
Gooley
T
T
Witherspoon
R P
RP
Sullivan
K M
KM
Storb
R
R
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous