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Central nervous system immune reconstitution inflammatory syndrome after autologous stem cell transplantation

Bone Marrow Transplantation volume 55, pages 268–271 (2020)Cite this article

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The immune reconstitution inflammatory syndrome (IRIS) represents a heterogeneous group of clinic and pathologic manifestations that can occur in previously immunosuppressed patients during the following rapid restoration of the immune function in the presence of a pathogen or a foreign antigen [1].

The diagnosis usually relies on the histological demonstration of sterile inflammatory infiltrates in the context of immune restoration, and on the identification of the specific pathogen against which the response is directed. The majority of patients with IRIS are HIV-positive subjects, whose immune system recovers after the initiation of a highly active antiretroviral therapy. However, IRIS has been also described in non-HIV-infected subjects recovering from immunosuppression, such as in women during the post-partum, in patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT) or solid organ transplant at the withdrawal of immunosuppressive medications, as well as in patients receiving chemotherapy or lymphocyte-depleting therapy during neutrophil recovery [2].

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References

  1. Barber DL, Andrade BB, Sereti I, Sher A. Immune reconstitution inflammatory syndrome: the trouble with immunity when you had none. Nat Rev Microbiol. 2012;10:150–6.

    Article  CAS  Google Scholar 

  2. Sun HY, Singh N. Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients. Curr Opin Infect Dis. 2009;22:394–402.

    Article  CAS  Google Scholar 

  3. Zając-Spychała O, Ukielska B, Jończyk-Potoczna K, Konatkowska B, Wachowiak J. Chronic candidiasis complicated by immune reconstitution inflammatory syndrome in child with acute lymphoblastic leukemia. Case Rep Hematol. 2016;2016:5960150.

    PubMed  PubMed Central  Google Scholar 

  4. López-Iñiguez A, Alejandro Carrera-Villanueva K, León-Rodríguez E, Cuellar-Rodriguez J. Recurrent arthritis and immune reconstitution inflammatory syndrome in hematopoietic stem cell transplantation (HSCT). Bone Marrow Transpl. 2018;53:374–6.

    Article  Google Scholar 

  5. Rushing EJ, Liappis A, Smirniotopoulos JD, Smith AB, Henry JM, Man YG, et al. Immune reconstitution inflammatory syndrome of the brain: Case illustrations of a challenging entity. J Neuropathol Exp Neurol. 2008;67:819–27.

    Article  Google Scholar 

  6. Johnson TP, Nath A. New insights into immune reconstitution inflammatory syndrome of the central nervous system. Curr Opin HIV AIDS. 2014;9:572–8.

    Article  CAS  Google Scholar 

  7. Rooney C, Sauer T. Modelling cytokine related syndrome. Nat Med. 2018;24:703–10.

    Article  Google Scholar 

  8. Cornell RF, Hari P, Drobyski WR. Engraftment syndrome after autologous stem cell transplantation: an update unifying the definition and management approach. Biol Blood Marrow Transpl. 2015;21:2061e2068.

    Article  Google Scholar 

  9. Ingram PR, Howman R, Leahy MF, Dyer J. Cryptococcal immune reconstitution inflammatory syndrome following alemtuzumab therapy. Clin Infec Dis. 2007;44:e115–7.

    Article  Google Scholar 

  10. Pruitt AA, Graus F, Rosenfeld MR. Neurological complications of transplantation: Part I: hematopoietic cell transplantation. Clin Infect Dis. 2013;3:24–38.

    Google Scholar 

  11. Cesaro S, Boaro MP, Pillon M, Calore E, Cermakova I, Perruccio K, et al. Immune reconstitution complicated by CMV retinitis in a pediatric patient who underwent haploidentical CD34+-selected hematopoietic stem cell transplant for acute lymphoblastic leukemia. Int J Hematol. 2008;88:145–8.

    Article  Google Scholar 

  12. Chan KL, Lokan J, Tam CS, Lew TE, Prince HM. Central nervous system immune reconstitution inflammatory syndrome after ibrutinib therapy for Richter transformation. Leuk Lymphoma. 2017;58:207–10.

    Article  Google Scholar 

  13. L Airas L, Päivärinta M, Röyttä M, Karhu J, Kauppila M, Itälä-Remes M, et al. Central nervous system immune reconstitution inflammatory syndrome (IRIS) after hematopoietic SCT. Bone Marrow Transpl. 2010;45:593–6.

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by grants from Fondazione Internazionale D’AMATO Onlus and Associazione per i Pazienti Ematologici (APE) Onlus. We are grateful to RomAIL (Associazione Italiana contro le Leucemie-linfomi e mieloma) for providing laboratory space and to David Calef for editing the manuscript.

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Authors and Affiliations

  1. Hematology, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy

    Alessia Campagna, Giusy Antolino, Sabrina Pelliccia, Giulia Galassi, Esmeralda Conte, Antonella Ferrari, Giacinto La Verde & Agostino Tafuri

  2. Laboratory of Cell Kinetics and Applied Proteomics, Faculty of Medicine and Psychology, Department of Clinic and Molecular Medicine, Sapienza University of Rome, Rome, Italy

    Valentina Gianfelici, Monica Piedimonte, Maria Paola Bianchi, Simone Mirabilii, Maria Rosaria Ricciardi & Agostino Tafuri

  3. Neurology, Department of Aging, Neurological and Head-Neck Sciences, A. Gemelli University Hospital, IRCCS, Rome, Italy

    Giorgio Tasca & Raffaele Iorio

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  1. Alessia Campagna
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Correspondence to Agostino Tafuri.

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Campagna, A., Gianfelici, V., Antolino, G. et al. Central nervous system immune reconstitution inflammatory syndrome after autologous stem cell transplantation. Bone Marrow Transplant 55, 268–271 (2020). https://doi.org/10.1038/s41409-019-0532-2

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