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Immune reconstitution and cytomegalovirus infection after allogeneic stem cell transplantation: the important impact of in vivo T cell depletion

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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.

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Acknowledgments

We thank Ms. C. Grobecker for her excellent data documentation. Dr. J. Weirowski made valuable grammatical and stylistic suggestions.

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Authors and Affiliations

  1. Medical Department III (Hematology, Oncology and Transfusion Medicine), Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    Martin Schmidt-Hieber, S. Schwarck, S. Ganepola, E. Thiel, L. Uharek & I. W. Blau

  2. Institute for Biometry and Clinical Epidemiology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    A. Stroux

  3. Department of Nephrology and Internal Intensive Care Medicine, Charité Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany

    P. Reinke

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  1. Martin Schmidt-Hieber
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  2. S. Schwarck
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Correspondence to Martin Schmidt-Hieber.

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Schmidt-Hieber, M., Schwarck, S., Stroux, A. et al. Immune reconstitution and cytomegalovirus infection after allogeneic stem cell transplantation: the important impact of in vivo T cell depletion. Int J Hematol 91, 877–885 (2010). https://doi.org/10.1007/s12185-010-0597-6

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  • DOI: https://doi.org/10.1007/s12185-010-0597-6

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