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How to define and measure thymopoiesis after transplantation?

Bone Marrow Transplantation volume 53, pages 1364–1365 (2018)Cite this article

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With great interest we read the recently published paper by Duinhouwer et al. [1], evaluating signal joint T-cell receptor excision circles (sjTREC) levels as measure for thymopoiesis after double umbilical cord blood transplantation (dUCBT). They report sjTRECs as soon as 3 months after dUCBT in their cohort of 55 adult patients, which they ascribe to fastened thymopoiesis because of the reduced intensity conditioning (RIC) without anti-thymocyte globulin in the conditioning regimen of their cohort. In addition, they evaluated the predictive value of sjTREC levels for outcome measures, and conclude that lower sjTREC levels at 3 months predict severe infections (grade 3–4 according to according to the NCI common toxicity criteria [CTC]).

Although the report of Duinhouwer et al. includes important topics in the field of hematopoietic transplantation, we have some concerns regarding their findings. First, we find the conclusion that sjTREC levels at 3 months after dUCBT predicts grade 3–4 CTC preliminary. In fact, most grade 3–4 CTC events in their cohort occur within the first 3 months (cumulative incidence is 80% at 3 months and 87% at 12 months), and the highest frequency of grade 3–4 CTC events occurs even within the first 30 days after transplantation. The relation might thus even be inverse, since others have shown that sjTREC levels can decrease upon T-cell expansion [2,3,4,5], such as during infections or graft-versus-host disease (GvHD). Therefore, a time-to-event model is pivotal to correctly evaluate the predictive value of sjTREC levels at 3 months for severe infections (grade 3–4 CTC) that mostly occur within this time frame.

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Authors and Affiliations

  1. Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands

    Coco de Koning, Stefan Nierkens & Jaap Jan Boelens

  2. UDAIR, Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands

    Stefan Nierkens

  3. Pediatric Blood and Marrow Transplantation Program, Wilhemina Children’s Hospital, Utrecht, The Netherlands

    Jaap Jan Boelens

  4. Princess Maxima Center for Pediatric Oncology, Blood and Marrow Transplantation Program, Utrecht, The Netherlands

    Jaap Jan Boelens

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  1. Coco de Koning
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Correspondence to Jaap Jan Boelens.

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de Koning, C., Nierkens, S. & Jan Boelens, J. How to define and measure thymopoiesis after transplantation?. Bone Marrow Transplant 53, 1364–1365 (2018). https://doi.org/10.1038/s41409-018-0199-0

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