| Insufficient recovery of thymopoiesis predicts for opportunistic infection in allogeneic hematopoietic stem cell transplantation recipients. | |
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MedLine Citation:
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PMID: 21859737 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background. Recovery of thymopoiesis after allogeneic hematopoietic stem cell transplantation is considered pivotal for full immune competence. However, it is still unclear to what extent insufficient recovery of thymopoiesis predicts for subsequent opportunistic infections and non-relapse mortality. Design and methods. A detailed survey of all post-engraftment infectious complications, non-relapse mortality and overall survival during long-term follow-up was performed in 83 recipients of allogeneic stem cell grafts after myeloablative conditioning. Recovery of thymopoiesis was assessed using signal joint T-cell receptor rearrangement excision circles analysis. The impact of recovery of thymopoiesis at 2, 6, 9 and 12 months post-transplantation on clinical outcome beyond those time points was evaluated by univariate and multivariate Cox regression analyses.Results. A cumulative incidence of 66% severe infections at 12 months after transplantation was noted with a median number of 1.64 severe infectious episodes per patient. Patients without recovery of thymopoiesis were at significantly higher risk for severe infections following multivariable analysis. Hazard ratio's indicated a 3- and 9-fold increase in severe infections following assessment at 6 and 12 months, respectively. Impaired recovery of thymopoiesis also translated into a higher risk for non-relapse mortality and outweighed pre-transplant risk factors including age, donor type, and disease risk-status. Conclusions. These results indicate that patients, who fail to recover thymopoiesis after allogeneic hematopoietic stem cell transplantation are at very high risk for severe infections and adverse clinical outcome. |
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Authors:
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Evert-Jan Wils; Bronno van der Holt; Annoek E C Broers; Sandra J Posthumus-van Sluijs; Jan-Willem Gratama; Eric Braakman; Jan J Cornelissen |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-8-22 |
Journal Detail:
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Title: Haematologica Volume: - ISSN: 1592-8721 ISO Abbreviation: - Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-8-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0417435 Medline TA: Haematologica Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Erasmus MC, Rotterdam, The Netherlands; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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