Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
5524375 | Biology of Blood and Marrow Transplantation | 2017 | 10 Pages |
â¢Impaired humoral immunity after hematopoietic stem cell transplantation is due to an IgM memory B cell maturation blockâ¢Chronic graft-versus-host disease is associated with lower IgM memory B cell countsâ¢Total body irradiation is associated with impaired B cell immune reconstitutionâ¢Hematopoietic stem cell transplantation with cord blood is associated with faster B cell immune reconstitution
Although T cell immune reconstitution after allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been well studied, long-term B cell immune reconstitution remains less characterized. We evaluated humoral immune reconstitution among 71 pediatric allo-HSCT recipients. Although tetanus toxoid antibody levels were normal at 1 year after allo-HSCT, antipolysaccharide carbohydrate antibodies remained persistently low for up to 5 years. While naive B cell counts normalized by 6 months, IgM memory B cell deficiency persisted for up to 2 years (Pâ=â.01); switched memory B cell deficiency normalized by 1 year after allo-HSCT. CD4+ T cell immune reconstitution correlated with that of switched memory B cells as early as 6 months after allo-HSCT (râ=â.55, Pâ=â.002) but did not correlate with IgM memory B cells at any time point after allo-HSCT. Taken together, this suggests that allo-HSCT recipients have impaired antibody immune reconstitution, mainly due to IgM memory B cell maturation block, compared with more prompt T cell-dependent switched memory cell immune reconstitution. We further explored other factors that might affect humoral immune reconstitution. The use of total body irradiation was associated with lower naive B cells counts at 6 months after HSCT (Pâ=â.04) and lower IgM (Pâ=â.008) and switched (Pâ=â.003) memory B cells up to 2 years. Allo-HSCT recipients with extensive chronic graft-versus-host disease had lower IgM memory B cell counts (Pâ=â.03) up to 2 years after allo-HSCT. The use of cord blood was associated with better naive (Pâ=â.01), IgM (Pâ=â.0005), and switched memory (Pâ=â.006) B cells immune reconstitution. These findings may inform future prophylaxis and treatment strategies regarding risk of overwhelming infection, graft-versus-host disease, and post-allogeneic HSCT revaccination.