title: Immunity of patients surviving 20 to 30 years after allogeneic or syngeneic bone marrow transplantation.
abstract: The duration of immunodeficiency following marrow transplantation is not known. Questionnaires were used to study the infection rates in 72 patients surviving 20 to 30 years after marrow grafting. Furthermore, in 33 of the 72 patients and in 16 donors (siblings who originally donated the marrow) leukocyte subsets were assessed by flow cytometry. T-cell receptor excision circles (TRECs), markers of T cells generated de novo, were quantitated by real-time polymerase chain reaction. Immunoglobulin G(2) (IgG(2)) and antigen-specific IgG levels were determined by enzyme-linked immunosorbent assay. Infections diagnosed more than [corrected] 15 years after transplantation occurred rarely. The average rate was 0.07 infections per patient-year (one infection every 14 years), excluding respiratory tract infections, gastroenteritis, lip sores, and hepatitis C. The counts of circulating monocytes, natural killer cells, B cells, CD4 T cells, and CD8 T cells in the patients were not lower than in the donors. The counts of TREC(+) CD4 T cells in transplant recipients younger than age 18 years (at the time of transplantation) were not different from the counts in their donors. In contrast, the counts of TREC(+) CD4 T cells were lower in transplant recipients age 18 years or older, even in those with no history of clinical extensive chronic graft-versus-host disease, compared with their donors. The levels of total IgG(2) and specific IgG against Haemophilus influenzae and Streptococcus pneumoniae were similar in patients and donors. Overall, the immunity of patients surviving 20 to 30 years after transplantation is normal or near normal. Patients who received transplants in adulthood have a clinically insignificant deficiency of de novo-generated CD4 T cells, suggesting that in these patients the posttransplantation thymic insufficiency may not be fully reversible.
authors.affiliation: Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA. jstorek@fhcrc.org
authors.forename: J
authors.initials: J
authors.lastname: Storek
authors.forename: A
authors.initials: A
authors.lastname: Joseph
authors.forename: G
authors.initials: G
authors.lastname: Espino
authors.forename: M A
authors.initials: MA
authors.lastname: Dawson
authors.forename: D C
authors.initials: DC
authors.lastname: Douek
authors.forename: K M
authors.initials: KM
authors.lastname: Sullivan
authors.forename: M E
authors.initials: ME
authors.lastname: Flowers
authors.forename: P
authors.initials: P
authors.lastname: Martin
authors.forename: G
authors.initials: G
authors.lastname: Mathioudakis
authors.forename: R A
authors.initials: RA
authors.lastname: Nash
authors.forename: R
authors.initials: R
authors.lastname: Storb
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: D G
authors.initials: DG
authors.lastname: Maloney
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D001402:B-Lymphocytes; D016026:Bone Marrow Transplantation / Q000276:immunology* / Q000401:mortality*; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes; D002648:Child; D002675:Child, Preschool; D005260:Female; D005434:Flow Cytometry; D006193:Haemophilus influenzae / Q000276:immunology; D006801:Humans; D007109:Immunity; D007074:Immunoglobulin G / Q000097:blood; D007239:Infections / Q000453:epidemiology; D007694:Killer Cells, Natural; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D009000:Monocytes; D016133:Polymerase Chain Reaction; D013296:Streptococcus pneumoniae / Q000276:immunology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D014185:Transplantation, Isogeneic
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G