Recovery from and consequences of severe iatrogenic lymphopenia (induced to treat autoimmune diseases).

Published

Journal Article

To ascertain the consequences of severe leukopenia and the tempo of recovery, we studied the immunity of 56 adult patients treated for multiple sclerosis or systemic sclerosis with autologous CD34 cell transplantation using extremely lymphoablative conditioning. NK cell, monocyte, and neutrophil counts recovered to normal by 1 month; dendritic cell and B cell counts by 6 months; and T cell counts by 2 years posttransplant, although CD4 T cell counts remained borderline low. Initial peripheral expansion was robust for CD8 T cells but only moderate for CD4 T cells. Subsequent thymopoiesis was slow, especially in older patients. Importantly, levels of antibodies, including autoantibodies, did not drop substantially. Infections were frequent during the first 6 months, when all immune cells were deficient, and surprisingly rare (0.21 per patient year) at 7-24 months posttransplant, when only T cells (particularly CD4 T cells) were deficient. In conclusion, peripheral expansion of CD8 but not CD4 T cells is highly efficient. Prolonged CD4 lymphopenia is associated with relatively few infections, possibly due to antibodies produced by persisting pretransplant plasma cells.

Full Text

Duke Authors

Cited Authors

  • Storek, J; Zhao, Z; Lin, E; Berger, T; McSweeney, PA; Nash, RA; Akatsuka, Y; Metcalf, MD; Lu, H; Kalina, T; Reindl, M; Storb, R; Hansen, JA; Sullivan, KM; Kraft, GH; Furst, DE; Maloney, DG

Published Date

  • December 2004

Published In

Volume / Issue

  • 113 / 3

Start / End Page

  • 285 - 298

PubMed ID

  • 15507394

Pubmed Central ID

  • 15507394

Electronic International Standard Serial Number (EISSN)

  • 1521-7035

International Standard Serial Number (ISSN)

  • 1521-6616

Digital Object Identifier (DOI)

  • 10.1016/j.clim.2004.07.006

Language

  • eng