title: Unrelated donor status and high donor age independently affect immunologic recovery after nonmyeloablative conditioning.
abstract: The risk of cytomegalovirus (CMV) infection is higher after HLA-matched unrelated donor (URD) than after HLA-matched related donor (MRD) nonmyeloablative hematopoietic cell transplantation (HCT). We therefore investigated factors affecting immune recovery in 94 patients given HCT from MRDs (n = 51) and URDs (n = 43) after 2-Gy total body irradiation with or without fludarabine and postgrafting immunosuppression with mycophenolate mofetil and cyclosporine. CD4 T cells counts remained below normal values during the first year after HCT in both patient groups. This included abnormally low counts each of naive CD4 T cells and memory CD4 T cells. Conversely, CD8 T cell counts reached the 10th percentile of normal 6 months after HCT in MRD and URD recipients. On day 30 after HCT, URD recipients had lower counts of B cells (P = .02), naive CD4 T cells (P = .04), memory CD4 T cells (P = .005), memory CD8 T cells (P = .005), and CMV-specific T helper cells (P = .007) than had MRD recipients. This delay in CMV-specific immune reconstitution translated into increased frequency of CMV antigenemia among URD recipients during the first 100 days after HCT. Older donor age was associated with low counts of naive CD4 T cells on days 180-365 after HCT (P = .003). Further, low numbers of T cells and CD34(+) cells in the graft and development of acute graft-versus-host disease were associated with impaired immune recovery of naive CD4 T cells and B cells. In summary, immunologic recovery was poor the first year after nonmyeloablative conditioning and was delayed among URD recipients in comparison with MRD recipients. Other factors significantly associated with delayed immune recovery were advanced donor age, low numbers of CD34 and T cells in the graft, and development of graft-versus-host disease.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-6072, USA.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Baron
authors.forename: Barry
authors.initials: B
authors.lastname: Storer
authors.forename: Michael B
authors.initials: MB
authors.lastname: Maris
authors.forename: Jan
authors.initials: J
authors.lastname: Storek
authors.forename: Fanny
authors.initials: F
authors.lastname: Piette
authors.forename: Monja
authors.initials: M
authors.lastname: Metcalf
authors.forename: Kristen
authors.initials: K
authors.lastname: White
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
authors.forename: Rainer
authors.initials: R
authors.lastname: Storb
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001521:Behavior Therapy / Q000379:methods; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes; D005260:Female; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006650:Histocompatibility Testing; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000009:adverse effects