Erschienen in:
01.06.2010 | Original Article
Immune reconstitution and cytomegalovirus infection after allogeneic stem cell transplantation: the important impact of in vivo T cell depletion
verfasst von:
Martin Schmidt-Hieber, S. Schwarck, A. Stroux, S. Ganepola, P. Reinke, E. Thiel, L. Uharek, I. W. Blau
Erschienen in:
International Journal of Hematology
|
Ausgabe 5/2010
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Abstract
We analyzed cytomegalovirus (CMV) infection risk factors and immune reconstitution kinetics in 89 patients after allogeneic stem cell transplantation (allo-SCT). The use of alemtuzumab for in vivo T cell depletion (TCD) had, besides the donor/recipient CMV serostatus, the strongest influence on the CMV infection risk in univariate and multivariate analyses. In comparison to without use of in vivo TCD, the CMV infection risk [hazard ratio (HR)] was 4.82-fold after TCD with alemtuzumab, but only 1.40-fold after TCD with antithymocyte globulin (ATG). Alemtuzumab strongly depressed CD4+ and CD8+ T cell reconstitution, whereas ATG only delayed CD4+ T cell reconstitution. Considering the reconstitution kinetics of CD4+ and CD8+ T cells, CMV-specific CD8+ T cells, NK cells and the IgG concentration, only a low day +60 NK cell count (≤161 versus >161/μl) was significantly associated with CMV infection development (HR 2.92, p = 0.034). CMV-specific CD8+ T cells were detected in 57% of patients with a CMV-seropositive donor, but in none of the patients with a CMV-seronegative donor on day +30 (p = 0.01). Our data indicate that the type of in vivo TCD (alemtuzumab or ATG) differentially influences both the CMV infection risk and CD4+/CD8+ T cell reconstitution kinetics in patients after allo-SCT.