Yazarlar : Bartelink IH, Belitser SV, Knibbe CA, Danhof M, de Pagter PJ, Egberts AC, Boelens JJ.

Yayın : Biol Blood Marrow Transplant

Yayın Yılı : 2012

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/23092812

Konu : Kemik İliği Nakli

Literatür İçeriği : The seriousness of complications of allogeneic haematopoietic stem cell transplantation (HSCT) is mainly governed by the status of the immune reconstitution. This study investigated differences in immune reconstitution with different cell sources and the association between the kinetics of immune reconstitution and mortality. Immunophenotyping was performed every 2 weeks in children who had received transplants between 2004 and 2008 in the University Mecidal Centre Utrecht. Lymphocyte reconstitution in the first 3 months after HSCT was studied in relation to mortality in three HSCT-groups: matched sibling bone marrow (35 patients), unrelated bone marrow (32 patients), and unrelated cord blood (36 patients). The median age was 5.9 years (range 0.1 - 21). The nature and speed of T- and B- and NK-cell reconstitution was highly dependent on the cell source. In the first 90 days after HSCT, a faster B- and NK-cell reconstitution and delayed T-cell reconstitution was shown in u-CB in comparison with id-SIB and u-BM recipients. Of the lymphocyte subsets investigated, a large number of NK-cells and a more rapid CD4+ immune reconstitution over time, resulting in sustained higher CD4+ counts, were the only predictors of a lower mortality risk in all cell sources. The final model showed that during the first 90 days, patients with an area under the CD4+ cell curve of > 4300 cells* day and no peak in CD4+ cell counts had the highest likelihood of survival (hazard ratio for mortality 0.2, 95% CI 0.06-0.5). In conclusion, the CD4+ kinetics may be used to identify patients at highest mortality risk early after HSCT.

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