title: Differences in Aspergillus-specific immune recovery between T-cell-replete and T-cell-depleted hematopoietic transplants.
abstract: BACKGROUND
  After hematopoietic stem cell transplantation, invasive aspergillosis remains one of the most lethal infections. Susceptibility may be due to prophylaxis and treatment of graft-vs.-host disease in T-cell-replete transplants, and delayed immune rebuilding due to T-cell depletion in haploidentical transplantation.
  
  
  METHODS
  We monitored CD4(+) T-cell recovery and anti-Aspergillus immune competence in pediatric recipients of T-cell-replete matched transplants and of prevalently adult recipients of T-cell-depleted matched or haploidentical transplants for hematological malignancies.
  
  
  RESULTS
  Although CD4(+) T-cell counts were higher in T-cell-replete transplant recipients at all post-transplant time points, Aspergillus-specific T cells were first detected 15-18 months after T-cell-replete matched, 7-9 months after T-cell-depleted matched, and 9-12 months after haploidentical transplantation, respectively. Incidence of invasive aspergillosis was 22% with 10% mortality after T-cell-replete transplants, 0% after T-cell-depleted matched, and 7% with 4% mortality after haploidentical transplants.
  
  
  CONCLUSIONS
  Although T-cell counts were significantly higher after T-cell-replete transplants, post-transplant immune suppression/GvHD appeared to impair their function. Specific Aspergillus immune competence recovered faster after T-cell-depleted transplants, whether matched or haploidentical. T-cell-replete transplants were associated with a higher incidence of invasive aspergillosis and Aspergillus-related deaths. These results showed that T-cell depletion without post-transplant immunosuppression is associated to a faster immune recovery than T-cell-replete transplantation.
authors: Pediatric Hematology Oncology, Azienda Ospedaliera-Universitaria, Perugia, Italy.
authors: Katia
authors: K
authors: Perruccio
authors: Division of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy.
authors: Fabiana
authors: F
authors: Topini
authors: Division of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy.
authors: Antonella
authors: A
authors: Tosti
authors: Pediatric Hematology Oncology, Department of Mother and Child Health, University of Padova, Padova, Italy.
authors: Maria Vittoria
authors: MV
authors: Gazzola
authors: Pediatric Hematology Oncology, Department of Mother and Child Health, University of Padova, Padova, Italy.
authors: Chiara
authors: C
authors: Messina
authors: Division of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy.
authors: Massimo F
authors: MF
authors: Martelli
authors: Pediatric Hematology Oncology, Azienda Ospedaliera-Universitaria, Perugia, Italy.
authors: Maurizio
authors: M
authors: Caniglia
authors: Division of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy.
authors: Andrea
authors: A
authors: Velardi
authors: Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors: Simone
authors: S
authors: Cesaro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000453:epidemiology / Q000209:etiology*; D001230:Aspergillus / Q000276:immunology*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007111:Immunity, Cellular; D016130:Immunophenotyping; D015994:Incidence; D007223:Infant; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D013601:T-Lymphocytes / Q000276:immunology* / Q000378:metabolism; D055815:Young Adult
keywords: antigen-specific T-cell responses; graft-versus-host disease; hematopoietic stem cell transplantation; immune recovery; immune suppression; invasive aspergillosis