Elsevier

Transplantation Proceedings

Volume 36, Issue 10, December 2004, Pages 3200-3202
Transplantation Proceedings

Monitoring of T-cell repertoire was useful for predicting graft-versus-host disease prognosis in a patient with chronic myelogeneous leukemia after allogeneic bone marrow transplantation

https://doi.org/10.1016/j.transproceed.2004.09.044Get rights and content

Abstract

We analyzed 24 T-cell receptor (TCR)β chain subfamilies (Vβ) and the chimerism of a patient with chronic myelogeneous leukemia who underwent allogeneic bone marrow transplantation (allo-BMT). The patient developed liver dysfunction at day 19 leading to worsening of his condition. He died on day 91 of hepatic failure. Complete donor chimerism was observed after day 19. The average complexity score of TCR-Vβ, which was low on day 19 (5.50), because much lower on day 82 (3.77). The average value of normal volunteers is 7.69. Neither immunosuppressive therapy nor antiviral therapy was effective to treat his hepatic dysfunction. A liver specimen at autopsy showed necrotic tissue with invasion of lymphocytes under the endothelial cells of the bile ducts. These findings suggest that the liver dysfunction was due to graft-versus-host disease (GVHD). Careful monitoring of chimerism and TCR-Vβ complexity may help to predict the prognosis of GVHD after allogeneic BMT.

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Discussion

During liver injury in this patient, the score of TCR-Vβ repertoires became low and TCR-Vβ reconstitution was delayed.3 Although immunosuppressive therapy resulted in limited recovery of the TCR repertoire, it was discontinued. The patient's lymphocyte counts were similar on days 19 and 82 using more than 105 CD3-positive T-cell samples. These findings suggest that the delayed recovery of TCR-Vβ was not related to the level of lymphocytes.4 In addition, delayed reconstitution of TCR-Vβ may have

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