מתוך medicontext.co.il
NEW YORK (Reuters Health) – Patients who survive at least 20 years after receiving a hematopoietic cell transplant are no longer significantly immunocompromised, according to a study of survivors in Seattle who underwent grafting before 1978.
Dr. Jan Storek, of the Fred Hutchinson Cancer Research Center in Seattle, and associates found that 72 patients of 289 who had undergone allogenic or syngeneic grafting had survived 20 to 30 years.
As reported in the December 15th issue of Blood, the patients had normal counts of monocytes, natural killer cells, total B cells, total CD4 T cells and total CD8 T cells. Also normal were levels of IgG-2 and IgG against common encapsulated bacteria.
However, levels of phenotypically naןve CD4 T cells and T-cell receptor excision circle (TREC+) CD4 T cells were reduced in the patients who received transplants at age 18 or older compared to control subjects. "It is possible that the thymic histologic defects observed early after transplantation, presumably induced by conditioning for graft-versus-host disease, may be only partially reversible in patients who received transplants as adults," the investigators theorized.
Tetanus toxoid-specific IgG levels were evaluated in 8 patients and 10 donors who had not undergone vaccination since the transplantation. Titers were lower in the patients than the donors, leading Dr. Storek's group to support recommendations for posttransplantation vaccination.
According to questionnaire responses, among patients who received transplants before age 18, there was one infection every 18 years between the 16th and the 30th year after transplantation. For those transplanted in adulthood, the rate was one every 11 years.
The site of infection was the lung in 14 cases. Other sites included the ear, paranasal sinuses, urinary tract or kidney, and skin or subcutis. There was one case each of oral thrush, bursitis due to Staphylococcus aureus, conjunctivitis, and sepsis associated with an injury. Overall the researchers consider the rate of infections to be "very low" in this cohort.
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