title: Defects in lymphocyte subsets and serological memory persist a median of 10 years after high-dose therapy and autologous progenitor cell rescue for malignant lymphoma.
abstract: The number of survivors having undergone high-dose therapy (HDT) followed by auto-SCT continues to increase, although some of the long-term sequelae remain incompletely understood. The immunological status and quality of life of 37 HDT/auto-SCT survivors with lymphoma in continuous remission of ≥3 years were assessed alongside 14 age-matched controls. At a median follow-up of 10.5 years (range 2.2-20.2) following HDT/auto-SCT, the proportion of CD4(+) cells remained significantly reduced in patients compared with controls (median 43.4% vs 62.5%, respectively; P = < 0.001), predominantly a result of sustained reduction in the naive CD4(+) component (P < 0.001). Naive CD8(+) lymphocytes (P = 0.014) and transitional B cells (P = 0.008) were also significantly reduced, but differences in other lymphocyte subsets were not observed. Uptake of revaccination following HDT/auto-SCT was sporadic; between 11% and 33% of patients had serological titres outside the protective ranges for five of six routinely used vaccines. In the main, patients were found to have a good quality of life, although their EORTC QLQ-C30 questionnaire scores were significantly lower for the physical and social functioning domains compared with controls. Ten years after HDT/auto-SCT immunological deficits persist; to avoid excess risk of preventable disease, serological immunity should be assessed post HDT/auto-SCT followed by appropriate revaccination.
authors.affiliation: Cancer Research UK Centre, Cancer Sciences Division, University of Southampton, Faculty of Medicine, Southampton, UK.
authors.forename: H F
authors.initials: HF
authors.lastname: Dean
authors.forename: A
authors.initials: A
authors.lastname: Cazaly
authors.forename: C
authors.initials: C
authors.lastname: Hurlock
authors.forename: J
authors.initials: J
authors.lastname: Borras
authors.forename: A P
authors.initials: AP
authors.lastname: Williams
authors.forename: P W
authors.initials: PW
authors.lastname: Johnson
authors.forename: A J
authors.initials: AJ
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016131:Lymphocyte Subsets / Q000187:drug effects / Q000276:immunology / Q000473:pathology*; D008214:Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D008223:Lymphoma / Q000188:drug therapy / Q000276:immunology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D017741:Survivors