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Immune Reconstitution

Immune reconstitution, infectious complications and post transplant supportive care measures after autologous blood and marrow transplantation in children

Bone Marrow Transplantation volume 32, pages 687–693 (2003)Cite this article

Summary:

We retrospectively analyzed data on T- and B-cell reconstitution and infectious complications in 58 children undergoing ABMT, in order to evaluate post-transplant supportive care measures used during the study period. Normalization of T-cell number and lymphocyte proli-ferative responses to phytohemagglutinin (PHA) and alloantigen (MLC) occurred in two-thirds of children by 6 months post transplant. Normal IgM levels developed in 75% of children by 6 months post transplant. A total of 34 children (59%) developed 39 episodes of infection between neutrophil engraftment and 1 year post transplant. The most common infections included bacteremia, varicella-zoster virus infection and pneumonia, which represented 46, 23 and 9% of infections, respectively. All patients with bacteremia had a central venous catheter in place at the time of infection. Most infections (77%) developed by 6 months post transplant. In this small patient cohort, time to normalization of tests of T- and B-cell function was not significantly different between patients with and without infection. Earlier removal of an indwelling central venous catheter may decrease the risk of bacteremia post transplant. Post-transplant supportive care measures may be discontinued at 6 months post ABMT in most children, as the risk of infection decreases after that time.

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References

  1. Guillaume T, Rubinstein DB, Symann M . Immune reconstitution and immunotherapy after autologous hematopoietic stem cell transplantation. Blood 1998; 92: 1471–1490.

    CAS  Google Scholar 

  2. Koehne G, Zeller W, Stockschlaeder M et al. Phenotype of lymphocyte subsets after autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1997; 19: 149–156.

    Article  CAS  Google Scholar 

  3. Nordoy T, Kolstad A, Endresen P et al. Persistent changes in the immune system 4–10 years after ABMT. Bone Marrow Transplant 1999; 24: 873–878.

    Article  CAS  Google Scholar 

  4. Schlenke P, Sheikhzadeh S, Weber K et al. Immune reconstitution and production of intracellular cytokines in T lymphocyte populations following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2001; 28: 251–257.

    Article  CAS  Google Scholar 

  5. Kalwak K, Gorczynska E, Toporski J et al. Immune reconstitution after haematopoietic cell transplantation in children: immunophenotype analysis with regard to factors affecting the speed of recovery. Br J Haematol 2002; 118: 74–89.

    Article  CAS  Google Scholar 

  6. Kamani N, Kattamis A, Carroll A et al. Immune reconstitution after autologous purged bone marrow transplantation in children. J Pediatr Hematol Oncol 2000; 22: 13–19.

    Article  CAS  Google Scholar 

  7. Steingrimsdottir H, Gruber A, Bjorkholm M et al. Immune reconstitution after autologous hematopoietic stem cell transplantation in relationship to underlying disease, type of high-dose therapy and infectious complications. Haematologica 2000; 85: 832–838.

    CAS  Google Scholar 

  8. Crippa F, Holmberg L, Carter R et al. Infectious complications after autologous CD34-selected peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 2002; 8: 281–289.

    Article  Google Scholar 

  9. Centers for Disease Control and Prevention. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. MMWR 2000; 49 (No. RR-10): 1–52.

  10. Dror Y, Gallagher R, Wara DW et al. Immune reconstitution in severe combined immunodeficiency disease after lectin-treated, T-cell-depleted haplocompatible bone marrow transplantation. Blood 1993; 81: 2021–2023.

    CAS  Google Scholar 

  11. Reynolds C, Seeger R, Black D et al. Model system for removing neuroblastoma cells from bone marrow using monoclonal antibodies and magnetic immunobeads. Cancer Res 1986; 46: 5882–5886.

    CAS  Google Scholar 

  12. Horn B, Reiss U, Matthay K et al. Veno-occlusive disease of the liver in children with solid tumors undergoing autologous hematopoietic progenitor cell transplantation: a high incidence in patients with neuroblastoma. Bone Marrow Transplant 2002; 29: 409–415.

    Article  CAS  Google Scholar 

  13. Mackall C, Stein D, Fleisher T et al. Prolonged CD4 depletion after sequential autologous peripheral blood progenitor cell infusion in children and young adults. Blood 2000; 96: 754–762.

    CAS  Google Scholar 

  14. Toor A, Van Burik J-A, Weisdorf D . Infections during mobilizing chemotherapy and following autologous stem cell transplantation. Bone Marrow Transplant 2001; 28: 1129–1134.

    Article  CAS  Google Scholar 

  15. Salazar R, Sola C, Maroto P et al. Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1999; 23: 27–33.

    Article  CAS  Google Scholar 

  16. Kolbe K, Domkin D, Derigs H et al. Infectious complications during neutropenia subsequent to peripheral blood stem cell transplantation. Bone Marrow Transplant 1997; 19: 143–147.

    Article  CAS  Google Scholar 

  17. Offidani M, Corvatta L, Olivieri A et al. Infectious complications after autologous peripheral blood progenitor cell transplantation followed by G-CSF. Bone Marrow Transplant 1999; 24: 1079–1087.

    Article  CAS  Google Scholar 

  18. Mossad S, Longworth D, Goormastic M et al. Early infectious complications in autologous bone marrow transplantation: a review of 219 patients. Bone Marrow Transplant 1996; 18: 265–271.

    CAS  Google Scholar 

  19. Romano V, Castagnola E, Dallorso S et al. Bloodstream infections can develop late (after day 100) and/or in the absence of neutropenia in children receiving allogeneic bone marrow transplantation. Bone Marrow Transplant 1999; 23: 271–275.

    Article  CAS  Google Scholar 

  20. Mullen C, Nair J, Sandesh S et al. Fever and neutropenia in pediatric hematopoietic stem cell transplant patients. Bone Marrow Transplant 2000; 25: 59–65.

    Article  CAS  Google Scholar 

  21. Bilgrami S, Chakraborty N, Rodriguez-Pinero F et al. Varicella zoster virus infection associated with high-dose chemotherapy and autologous stem-cell rescue. Bone Marrow Transplant 1999; 23: 469–474.

    Article  CAS  Google Scholar 

  22. Leung T, Chik K, Li C et al. Incidence, risk factors and outcome of varicella-zoster virus infection in children after haematopoietic stem cell transplantation. Bone Marrow Transplant 2000; 25: 167–172.

    Article  CAS  Google Scholar 

  23. Crippa F, Holmberg L, Carter R et al. Infectious complications after autologous CD34-selected peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 2002; 8: 281–289.

    Article  Google Scholar 

  24. Steer C, Szer J, Sasadeusz J et al. Varicella-zoster infection after allogeneic bone marrow transplantation: incidence, risk factors and prevention with low-dose aciclovir and ganciclovir. Bone Marrow Transplant 2000; 25: 657–664.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. University of Kiel Medical Center, Germany

    J Machatschek

  2. Bone Marrow Transplant Division and Pediatric Hematology/Oncology, UCSF Children's Hospital at University of California Medical Center, San Francisco, CA, USA

    J Machatschek, J Duda, K Matthay, M Cowan & B Horn

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  1. J Machatschek
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  2. J Duda
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  3. K Matthay
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  4. M Cowan
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  5. B Horn
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Correspondence to B Horn.

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Machatschek, J., Duda, J., Matthay, K. et al. Immune reconstitution, infectious complications and post transplant supportive care measures after autologous blood and marrow transplantation in children. Bone Marrow Transplant 32, 687–693 (2003). https://doi.org/10.1038/sj.bmt.1704196

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