Immune Reconstitution Following Hematopoietic Cell Transplantation
Hematopoietic Stem Cell Transplantation
© 2016 John Wiley & Sons, Ltd. All rights reserved.Hematopoietic cell transplantation (HCT) is complicated by post-transplant immune deficiency, which is more profound after allogeneic than autologous HCT. Cytoreductive conditioning regimens eliminate tumor cells and significantly deplete the recipient's immune system, in particular cells of the lymphoid lineageand allow for successful engraftment of hematopoietic stem cells (HSCs) in their bone marrow niche. This chapter reviews immune reconstitution following HCT, with a particular emphasis on factors that contribute to delayed immune recovery post-transplant and the clinical consequences. It also discusses current clinical and research assays to monitor post-HCT immune recovery and highlights some of the potential strategies that are currently under investigation to enhance immune recovery in HCT recipients. Post-transplant immune deficiency is due to a variety of factors, including age-dependent thymic involution, conditioning-induced thymic damage, thymic GVHD, GVHD prophylaxis including in vivo or ex vivo T cell depletion, and treatment with immune-suppressive drugs.
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