Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Immunological Recovery

Immunologic recovery after autologous blood stem cell transplantation in patients with AL-amyloidosis

Bone Marrow Transplantation volume 28, pages 1105–1109 (2001)Cite this article

Abstract

We prospectively studied absolute lymphocyte (ALC) and monocyte counts (AMC), lymphocyte subsets and proliferative in vitro responses to mitogen and antigen in 12 patients with AL-amyloidosis (AL) undergoing autologous blood stem cell transplantation (SCT) with high-dose i.v. melphalan. Myeloid and lymphoid recovery (>500 per μl) occurred in a median of 10 days post SCT. While there was a continuous decline in the number of CD4+ T cells at 3 months, ALC, AMC, B cells (CD19+), CD8+ T cells, and NK cells (CD16+/56+) returned to baseline. While T cell proliferative responses to phytohemagglutinin (PHA) remained depressed, B cell function measured by the proliferative response to staphylococcal antigen returned to baseline by 3 months. To supplement our findings, we retrospectively evaluated ALC, AMC and serum immunoglobulin levels in a separate group of patients treated with the same protocol at our institution. ALC and AMC recovery was similar to the pattern observed in the initial study group. Immunoglobulin levels remained within normal ranges at 3 and 12 months after SCT. Of 50 patients who were followed for a minimum of 1 year following SCT, seven (14%) developed shingles and one (2%) had PCP pneumonia. In conclusion, cellular immune function, reflected by absolute numbers of CD4+ T cells and PHA responsive T cell proliferation, is significantly suppressed at 3 months after SCT in patients with AL, and this post-transplant immunosuppression is associated with a low but clinically meaningful occurrence of opportunistic infections typical of T cell immunosuppression.

Bone Marrow Transplantation (2001) 28, 1105–1109.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Comenzo, RL, Vosburgh E, Simms RW et al. Dose-intensive melphalan with blood stem cell support for the treatment of AL-amyloidosis: one-year follow-up in five patients Blood 1996 88: 2801–2806

    CAS  PubMed  Google Scholar 

  2. Comenzo RL, Vosburgh E, Falk RH et al. Dose-intensive melphalan with blood stem cell support for the treatment of AL (amyloid light-chain) amyloidosis: survival and responses in 25 patients Blood 1998 91: 3662–3670

    CAS  PubMed  Google Scholar 

  3. Lum LG . The kinetics of immune reconstitution after human marrow transplantation Blood 1987 69: 369–380

    CAS  PubMed  Google Scholar 

  4. Paulin T, Ringden O, Nilsson B . Immunological recovery after bone marrow transplantation. Role of age, graft-versus-host disease, prednisolone treatment and infections Bone Marrow Transplant 1987 1: 317–328

    CAS  PubMed  Google Scholar 

  5. Witherspoon R, Deeg HJ, Lum L et al. Immunological recovery in human marrow graft recipients given cyclosporine or methotrexate for the prevention of graft-versus-host disease Transplantation 1984 37: 456–461

    Article  CAS  Google Scholar 

  6. Ottinger HD, Belen DW, Scheulen B et al. Improved immune reconstitution after allotransplantation of peripheral blood stem cells instead of bone marrow Blood 1996 88: 2775–2779

    CAS  PubMed  Google Scholar 

  7. Keever CA, Small TN, Flomenberg N et al. Immune reconstitution following bone marrow transplantation: comparison of recipients of T-cell depleted marrow with recipients of conventional marrow grafts Blood 1989 73: 1340–1350

    CAS  PubMed  Google Scholar 

  8. Roux E, Helg C, Dumont-Girard F et al. Analysis of T-cell repopulation after allogeneic bone marrow transplantation: significant difference between recipients of T-cell depleted and unmanipulated grafts Blood 1996 87: 3984–3992

    CAS  PubMed  Google Scholar 

  9. Randelli D, Re F, Bandini G et al. Different immune reconstitution in multiple myeloma, chronic myeloid leukemia and acute myeloid leukemia patients after allogeneic transplantation of peripheral blood stem cells Bone Marrow Transplant 2000 26: 1325–1331

    Article  Google Scholar 

  10. Sanchorawala V, Vosburgh E, Fisher C et al. Infectious complications in patients with AL Amyloidosis undergoing autologous blood stem cell transplantation. In: RA Kyle, MA Gertz (eds) Amyloid and Amyloidosis Parathenon: New York 1999 pp 190–192

    Google Scholar 

  11. Comenzo RL . Hematopoietic cell transplantation for primary systemic amyloidosis: what have we learned Leuk Lymphoma 2000 37: 245–258

    Article  CAS  Google Scholar 

  12. Comenzo RL, Malachowski ME, Miller KB et al. Engraftment with peripheral blood stem cells collected by large-volume leukapheresis for patients with lymphoma Transfusion 1992 32: 729–731

    Article  CAS  Google Scholar 

  13. Symann M, Bosly A, Gisselbrecht C et al. Immune reconstitution after bone marrow transplantation (review) Cancer Treatment Rev 1989 16: 15–19

    Article  Google Scholar 

  14. Sugita K, Soiffer RJ, Murray C et al. The phenotype and reconstitution of immunoregulatory T cell subsets after T-cell depleted allogeneic and autologous bone marrow transplantation Transplantation 1994 57: 1465–1473

    Article  CAS  Google Scholar 

  15. Olsen GA, Gockerman JP, Bast RC et al. Altered immunologic reconstitution after standard-dose chemotherapy or high dose chemotherapy with autologous bone marrow support Transplantation 1988 46: 57–60

    Article  CAS  Google Scholar 

  16. Bengtsson M, Totterman TH, Smedmyr B et al. Regeneration of functional and activated NK and T subset cells in the marrow and blood after autologous bone marrow transplantation: a prospective phenotypic study with 2/3-color FACS analysis Leukemia 1989 3: 68–75

    CAS  PubMed  Google Scholar 

  17. Bensinger WI, Martin PJ, Storer B et al. Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers New Engl J Med 2001 344: 175–181

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Dr Thomas Rothstein, who provided his immunology laboratory for us to perform in vitro assays and Dina Pelley from the Clinical Flow Cytometry Laboratory at Boston University Medical Center for the immunophenotypic analyses. This work was supported by JoAnn McCaleb Amyloid Research Award, Boston University School of Medicine, Boston MA and published in the Proceeding of American Society of Hematology Meeting in Miami FL, 1998.

Author information

Authors and Affiliations

  1. Department of Medicine, Section of Hematology and Oncology, Boston University Medical Center, Boston, MA, USA

    G Akpek, G Lenz, V Sanchorawala, DG Wright, T Colarusso, K Waraska, A Lerner, E Vosburgh & RL Comenzo

  2. Department of Medicine, Amyloid Program, Boston University Medical Center, Boston, MA, USA

    G Akpek, V Sanchorawala, DG Wright, E Vosburgh, M Skinner & RL Comenzo

  3. Division of Hematologic Malignancies, Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    G Akpek

  4. Division of Biostatistics, Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    SM Lee

  5. Hematology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    RL Comenzo

Authors
  1. G Akpek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Lenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. SM Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V Sanchorawala
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. DG Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T Colarusso
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K Waraska
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A Lerner
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E Vosburgh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M Skinner
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. RL Comenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Akpek, G., Lenz, G., Lee, S. et al. Immunologic recovery after autologous blood stem cell transplantation in patients with AL-amyloidosis. Bone Marrow Transplant 28, 1105–1109 (2001). https://doi.org/10.1038/sj.bmt.1703298

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1703298

Keywords

This article is cited by

Search

Advanced search

Quick links