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Graft-Versus-Host Disease

Impact of early NK cell recovery on development of GvHD and CMV reactivation in dose-reduced regimen prior to allogeneic PBSCT

Bone Marrow Transplantation volume 35, pages 183–190 (2005)Cite this article

Abstract

Summary:

Dose-reduced allogeneic peripheral blood stem cell transplantation (PBSCT) is a therapeutic approach for patients with haematological malignancies who are not eligible for conventional allogeneic PBSCT. We analysed early development of lymphocyte subpopulations and the occurrence of cytomegalovirus (CMV) reactivation and acute graft-versus-host reaction (GvHD) in patients undergoing the protocol according to Slavin vs conventionally treated patients. Lymphocyte status prior to conditioning and at day +30 after allogeneic PBSCT was determined in 24 out of 51 patients who received conventional allogeneic PBSCT (eg cyclophosphamide plus total body irradiation) and compared with 27 patients being treated according to the Slavin protocol (fludarabine, busulphan and ATG). There is a significant delay in CD4 (T helper) cell development and consecutive lower CD4/CD8 ratios and a better reconstitution of CD8 (T cytotoxic) and NK (natural killer) cells after the Slavin protocol. Patients undergoing this protocol and no, or only grade I, acute GvHD show an even better NK cell reconstitution compared to patients with grade II–IV GvHD. A low CD4/CD8 ratio represents a CMV risk factor only in conventionally treated patients with grade 0–I GvHD, while after preparative regimen according to the Slavin protocol, the NK/CD8 ratio might be a marker for the prediction of CMV reactivation in addition to CMV risk status.

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Acknowledgements

We are especially grateful to Professor M Boeckh (FHCRC, Seattle) for a critical reading of the manuscript and his helpful recommendations during the preparation. We also thank Ms Franke and Ms Herrmann for FACS analyses of peripheral blood lymphocytes and A Markusch for excellent help in analyses of patient data.

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  1. Mildred Scheel Station für Knochenmarktransplantation, Department of Internal Medicine II, Medical Faculty, Friedrich Schiller University, Jena, Germany

    S Scholl, L O Mügge, M Charbel Issa, C Kasper, K Pachmann, K Höffken & H G Sayer

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  1. S Scholl
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Correspondence to S Scholl.

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Scholl, S., Mügge, L., Charbel Issa, M. et al. Impact of early NK cell recovery on development of GvHD and CMV reactivation in dose-reduced regimen prior to allogeneic PBSCT. Bone Marrow Transplant 35, 183–190 (2005). https://doi.org/10.1038/sj.bmt.1704752

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