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Insufficient recovery of thymopoiesis predicts for opportunistic infections in allogeneic hematopoietic stem cell transplant recipients
- Source :
- Haematologica, 96(12), 1846-1854. Ferrata Storti Foundation
- Publication Year :
- 2011
-
Abstract
- 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 analysis of signal joint T-cell receptor rearrangement excision circles. 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 The cumulative incidence of severe infections at 12 months after transplantation was 66% with a median number of 1.64 severe infectious episodes per patient. Patients in whom thymopoiesis did not recover were at significantly higher risk of severe infections according to multivariable analysis. Hazard ratios indicated 3- and 9-fold increases in severe infections at 6 and 12 months, respectively. Impaired recovery of thymopoiesis also translated into a higher risk of 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 of severe infections and adverse clinical outcome.
- Subjects :
- Adult
Male
Oncology
medicine.medical_specialty
Time Factors
Adolescent
medicine.medical_treatment
Thymus Gland
Hematopoietic stem cell transplantation
Disease
Opportunistic Infections
Biology
Disease-Free Survival
Risk Factors
Internal medicine
medicine
Humans
Transplantation, Homologous
Cumulative incidence
Survival rate
Proportional hazards model
Incidence
Hazard ratio
Hematopoietic Stem Cell Transplantation
Recovery of Function
Original Articles
Hematology
Middle Aged
Survival Rate
Transplantation
Hematologic Neoplasms
Immunology
Female
Stem cell
Follow-Up Studies
Subjects
Details
- ISSN :
- 03906078
- Volume :
- 96
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- Haematologica
- Accession number :
- edsair.doi.dedup.....81b4b55f0e269821c93a98b32f9597ac