Springer Online Journal Archives 1860-2000
Abstract Patients undergoing bone marrow transplantation are susceptible to many different bacterial, fungal and viral infections. Among the viral pathogens, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and adenovirus cause the greatest morbidity and mortality and have been the most common infectious causes of death following the grafting of allogeneic marrow. This great susceptibility to viral infections is due to the immunodeficiency in cellular and humoral immune responses lasting for months to years. Contributing factors are high-dose chemo/radiotherapy, graft-versus-host disease (GVHD) prophylaxis/treatment, GVHD itself, the degree of HLA disparity between donor and recipient and the underlying disease. Defects of T cell helper and cytotoxic functions contribute to the great incidence of viral infections. We described here the kinetic of immunological reconstituion and the role of T cell immunodeficiency. At day 30 to 40 after BMT, a minority of patients had recovery of virus-specific CD8+ T-cell response. Between day 40 and day 90 recovery of deficient CD8+ and CD4+ T cell responses occured in the majority of the recipients of HLA identical BMT but only in the minority of the recipients of HLA partially incompatible BMT. New approaches should therefore be envisaged either to preserve donor T-cell-mediate immunity or tho accelerate immune reconstitution. Add-back of unmanipulated T-cells, or virus-specific T cells could improve antimicrobial defenses after BMT.
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