Dean, H. F, Cazaly, A, Hurlock, C., Borras, J., Williams, A. P., Johnson, Peter W.M. and Davies, A. J.
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 (doi:10.1038/bmt.2012.73). (PMID:22580768).
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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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