Defects in lymphocyte subsets and serological memory persist a median of 10 years after high-dose therapy and autologous progenitor cell rescue for malignant lymphoma

Dean, H.F., Cazaly, A., Hurlock, C., Borras, J., Williams, A.P., Johnson, Peter W.M. and Davies, A.J. (2012) Defects in lymphocyte subsets and serological memory persist a median of 10 years after high-dose therapy and autologous progenitor cell rescue for malignant lymphoma. Bone Marrow Transplantation, 47 (12), 1545–1551. (doi:10.1038/bmt.2012.73). (PMID:22580768)

Abstract

The number of survivors having undergone high-dose therapy (HDT) followed by auto-SCT continues to increase, although some of the long-term sequelae remain incompletely understood. The immunological status and quality of life of 37 HDT/auto-SCT survivors with lymphoma in continuous remission of ?3 years were assessed alongside 14 age-matched controls. At a median follow-up of 10.5 years (range 2.2-20.2) following HDT/auto-SCT, the proportion of CD4(+) cells remained significantly reduced in patients compared with controls (median 43.4% vs 62.5%, respectively; P=<0.001), predominantly a result of sustained reduction in the naive CD4(+) component (P<0.001). Naive CD8(+) lymphocytes (P=0.014) and transitional B cells (P=0.008) were also significantly reduced, but differences in other lymphocyte subsets were not observed. Uptake of revaccination following HDT/auto-SCT was sporadic; between 11% and 33% of patients had serological titres outside the protective ranges for five of six routinely used vaccines. In the main, patients were found to have a good quality of life, although their EORTC QLQ-C30 questionnaire scores were significantly lower for the physical and social functioning domains compared with controls. Ten years after HDT/auto-SCT immunological deficits persist; to avoid excess risk of preventable disease, serological immunity should be assessed post HDT/auto-SCT followed by appropriate revaccination.Bone Marrow Transplantation advance online publication, 14 May 2012; doi:10.1038/bmt.2012.73.

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Contributors

Author: Peter W.M. Johnson

Author: A.J. Davies

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