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The thymus is typically small at 1 year after autologous or allogeneic T-cell-replete hematopoietic cell transplantation into adults

Bone Marrow Transplantation volume 34, pages 829–830 (2004)Cite this article

Hematopoietic cell transplantation (HCT) is complicated by infections due at least in part to prolonged CD4 lymphopenia.1, 2 In adult patients, CD4 T-cell counts are low for more than 5 years following allogeneic transplantation.3 De novo T-cell generation (from hematopoietic cells) is essential for complete recovery of CD4 T-cell counts.4, 5 De novo generation does occur in adult, even 50–66-year-old, HCT recipients as evidenced by rising T-cell receptor excision circles in the first year post transplant.4, 6, 7, 8, 9, 10 Given that de novo generation of T cells is thought to take place primarily or entirely in the thymus, it might be expected that the thymus of adult HCT recipients should be large. We here present data showing that the thymus at 1 year post transplant is generally of small size (thymic index ⩽2 on McCune's scale (⩽2 – small, 3 – intermediate, 4–5 – large)11).

We retrospectively studied chest computer tomograms (CT) of 42 patients undergoing HCT for lymphoma, as it is customary to perform CT at 1 year after transplant for lymphoma restaging. A total of 363 patients underwent autologous or HLA-matched sibling HCT at the Fred Hutchinson Cancer Research Center for lymphoma between January 1, 1991 and June 30, 2002. Nine patients were excluded due to age <16 years as the focus of the study was on adult HCT recipients. A total of 40 patients were excluded due to lymphoma relapse and three patients due to a secondary malignancy (other than squamous or basal cell skin cancer) diagnosed by the time of the 1 year post transplant CT. Seven patients were excluded because of prior mediastinal irradiation. For 260 patients, the CT images were unavailable as either the radiology facilities where the CT had been done did not collaborate or the CT images had been discarded. Of the remaining 44 patients, the thymic size could not be evaluated in two patients due to presumed mediastinal fibrosis. Autologous HCT recipients were typically conditioned with cyclophosphamide (100 mg/kg), etoposide (60 mg/kg) and fractionated total body irradiation (fTBI, 12 Gy), young (⩽45 years old) allogeneic HCT recipients with cyclophosphamide (120 mg/kg) and fTBI (12–16 Gy) and older (>45 years old) allogeneic HCT recipients with fludarabine (90 mg/m2) and TBI (2 Gy). Grafts were not depleted of T cells. GVHD prophylaxis (given to allograft recipients only) typically consisted of cyclosporine with methotrexate or mycophenolate mofetil. All 19 allograft recipients developed clinical chronic GVHD in the first year post transplant. This necessitated treatment with immunosuppressive drugs in the first year post transplant in 16 of the 19 patients. Thymic index (a semiquantitative determination of thymic size) was determined as described by McCune et al,11 except that a scale of 1–5 was used (1 denotes 0 or 1 of McCune's scale). The determination was carried out by one radiologist (BAP) blinded to clinical data. The study was approved by the Institutional Review Board.

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Acknowledgements

The study was supported by National Institutes of Health grants No. AI46108 and HL69710.

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  1. Fred Hutchinson Cancer Research Center, University of Washington, and First Hill Diagnostic Imaging, D1-100, 1100 Fairview Avenue N, Seattle, 98109-1024, WA, USA

    J Storek, J H Staver, B A Porter & D G Maloney

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  1. J Storek
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Storek, J., Staver, J., Porter, B. et al. The thymus is typically small at 1 year after autologous or allogeneic T-cell-replete hematopoietic cell transplantation into adults. Bone Marrow Transplant 34, 829–830 (2004). https://doi.org/10.1038/sj.bmt.1704635

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