Factors affecting reconstitution of the T cell compartment in allogeneic haematopoietic cell transplant recipients

PR Fallen, L McGreavey, JA Madrigal… - Bone marrow …, 2003 - nature.com
PR Fallen, L McGreavey, JA Madrigal, M Potter, M Ethell, HG Prentice, A Guimaraes…
Bone marrow transplantation, 2003nature.com
The factors affecting T cell reconstitution post haematopoietic cell transplantation (HCT) are
not well characterised. We carried out a longitudinal analysis of T cell reconstitution in 32
HCT recipients during the first 12 months post transplant. We analysed reconstitution of
naïve, memory and effector T cells, their diversity and monitored thymic output using TCR
rearrangement excision circles (TRECs). Thymic-independent pathways were responsible
for the rapid reconstitution of memory and effector T cells less than 6 months post HCT …
Summary
The factors affecting T cell reconstitution post haematopoietic cell transplantation (HCT) are not well characterised. We carried out a longitudinal analysis of T cell reconstitution in 32 HCT recipients during the first 12 months post transplant. We analysed reconstitution of naïve, memory and effector T cells, their diversity and monitored thymic output using TCR rearrangement excision circles (TRECs). Thymic-independent pathways were responsible for the rapid reconstitution of memory and effector T cells less than 6 months post HCT. Thymic-dependent pathways were activated between 6 and 12 months in the majority of patients with naïve T cell numbers increasing in parallel with TREC levels. Increasing patient age, chronic GVHD and T cell depletion (with or without pretransplant Campath-1H) predicted low TREC levels and slow naïve T cell recovery. Furthermore, increasing patient age also predicted high memory and effector T cell numbers. The effects of post HCT immunosuppression, total body irradiation, donor leucocyte infusions, T cell dose and post HCT infections on T cell recovery were also analysed. However, no effects of these single variables across a variety of different age, GVHD and T cell depletion groups were apparent. This study suggests that future analysis of the factors affecting T cell reconstitution and studies aimed at reactivating the thymus through therapeutic intervention should be analysed in age-, GVHD-and TCD-matched patient groups.
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