Characteristics and influencing factors of CD19+ B cell reconstitution in patients following haploidentical/mismatched hematopoietic stem cell transplantation.
In patients undergoing hematopoietic stem cell transplantation (HSCT), B cells exert important, prolonged effects that provide protection from infection. In this study, we analyzed characteristics and influencing factors of CD19+ B cell reconstitution in 83 patients who underwent unmanipulated haploidentical/mismatched blood and bone marrow transplantation. Of these patients, 45 % showed a normal CD19+ B cell count at +360 days. Factors associated with lower CD19+ B cell levels were as follows: aGVHD grades II-IV had a trend to affect CD19+ B cell reconstitution at +180 days; clinically extensive cGVHD was significantly associated with CD19+ B cell deficiency at +360 days and serum IgG level at +180 and +360 days; cytomegalovirus (CMV) infection occurred after +38 days was correlated with lower B cell level at both +90 and +360 days, while those occurred before +38 days did not show this effect; glucocorticoids used around +90 and +180 days was associated with lower CD19+ B cell levels at +90 and +360 days, respectively, especially in patients that did not experience extensive cGVHD. In contrast, the number of HLA-mismatched locus positively correlated with CD19+ B cell at +90 days and serum IgG level at +180 days. In conclusion, CD19+ B cell recovery after haploidentical/mismatched HSCT was mainly influenced by GVHD and/or its treatment, CMV infection that occurred later (after +38 days) and use of glucocorticoids. Improvement of B cell recovery is likely to be achieved through effective prophylaxis of GVHD, minimized use of glucocorticoids, and preemptive treatment of CMV infection occurring after +38 days. More HLA-mismatched loci may initiate a stronger humoral response toward alloantigens >180 days after HSCT, which may be beneficial for the eradication of minimal residual disease and protection from infection.
Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No 11 Xizhimen South Street, Beijing, China. xiemin@bjmu.edu.cn
Min
M
Xie
Hai-Xia
HX
Fu
Ying-Jun
YJ
Chang
Lan-Ping
LP
Xu
Dai-Hong
DH
Liu
Xiao-Hui
XH
Zhang
Wei
W
Han
Kai-Yan
KY
Liu
Xiao-Jun
XJ
Huang
D000293:Adolescent; D000328:Adult; D018941:Antigens, CD19 / Q000378:metabolism; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology* / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology; D006086:Graft vs Host Disease / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006648:Histocompatibility / Q000187:drug effects / Q000235:genetics* / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000494:pharmacology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
D018941:Antigens, CD19; D005938:Glucocorticoids; D006680:HLA Antigens; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents