[en] Mismatched unrelated donor (MMUD) or umbilical cord blood (UCB) can be chosen as alternative donors for allogeneic stem cell transplantation but might be associated with long lasting immune deficiency. Sixty-six patients who underwent a first transplantation from either UCB or 9/10 MMUD (n= 36) and who survived beyond 3 months were evaluated. Immune reconstitution was prospectively assessed at sequential time points after transplantation. NK, B, CD4+ and CD8+T cells and their subsets as well as regulatory T cells (Treg) were studied. Detailed analyses on infections occurring after 3 months were also assessed. The 18-month cumulative incidences of infection-related death were 8 and 3%, and of infections were 72 and 57% after MMUD and UCB transplantation, respectively. Rates of infection per 12 patient-month were roughly 2 overall (1 for bacterial, 0.9 for viral and 0.3 for fungal infections). Memory, naïve CD4+ and CD8+T cells, naïve B cells and Treg cells reconstitution between the 2 sources was roughly similar. Absolute CD4+T cells hardly reached 500 per μL by one year posttransplantation and most B cells were of naïve phenotype. Correlations between immune reconstitution and infection were then performed by multivariate analyses. Low CD4+ and high CD8+T cells absolute counts at 3 months were linked to increased risks of overall and viral (but not bacterial) infections. When assessing for the naïve/memory phenotypes at 3 months among the CD4+ T cell compartment, higher percentages of memory subsets were protective against late infections: central memory CD4+T cells protected against overall and bacterial infections; late effector memory CD4+T cells protected against overall, bacterial and viral infections. At the opposite, high percentage of
effector- and late effector-memory subsets at 3 months among the CD8+ T cell compartment
predicted higher risks for viral infections. Patients transplanted from alternative donors represent a population with very high risk of infection. Detailed phenotypic analysis of immune reconstitution may help to evaluate infection risk and to adjust infection prophylaxis.
Disciplines :
Hematology
Author, co-author :
SERVAIS, Sophie ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Lengline, Etienne; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Hematology, Bone Marrow Transplantation Unit
Porcher, Raphael; University Paris Diderot, Sorbonne Paris Cité, Paris, France > APH-HP, Hopital Saint-Louis > Biostatistics
Carmagnat, Maryvonnick; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Immunology
Peffault de Latour, Régis; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Hematology, Bone Marrow Transplantation Unit
Robin, Marie; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Hematology, Bone Marrow Transplantation Unit
Sicre de Fontebrune, Flore; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Hematology, Bone Marrow Transplantation Unit
Clave, Emmanuel; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Immunology
Maki, Guitta; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Immunology
Granier, Clémence; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Immunology
Xhaard, Aliénor; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Hematology, Bone Marrow Transplantation Unit
Dhedin, Nathalie; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Hematology, Bone Marrow Transplantation Unit
Molina, Jean-Michel; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Service des Maladies Infectieuses et Tropicales,
Toubert, Antoine; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Immunology
Moins-Teisserenc, Hélène; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Immunology
Socie, Gérard; University Paris Diderot, Sorbonne Paris Cité, Paris, France > AP-HP, Hopital Saint-Louis > Hematology, Bone Marrow Transplantation Unit
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