Summary:We previously described skewed repertoires of the T cell receptor- chain variable region (TCRBV) and the TCR-␣ chain variable region (TCRAV) soon after allogeneic hematopoietic cell transplantation. To determine the characteristics of skewed TCRBV after transplantation, we examined the clonality of T lymphocytes carrying skewed TCRBV subfamilies and determined the CDR3 sequences of expanded T cell clones. In all 11 recipients examined, TCR repertoires were skewed, with an increase of certain TCRBV subfamilies that differed among individuals. In nine of 11 patients, clonal/oligoclonal T cell expansion was observed, although the expanded T cells were not necessarily oligoclonal. The extent of expansion after transplantation appeared to predict clonality. The arginine (R)-X-X-glycine (G) sequence was identified in clonally expanded T cells from four of five recipients examined, and glutamic acid (E), aspartic acid (D) and alanine (A) were frequently inserted between R and G. These results suggest that T lymphocyte expansion may result from the response to antigens widely existing in humans, and that the extensive clonal expansion of a limited number of T cells leads to contracted CDR3 diversity and post-transplant skewed TCR repertoires. Bone Marrow Transplantation (2001) 27, 607-614. Keywords: T cell clonality; CDR3; allogeneic hematopoietic cell transplantationWe have found skewed TCRAV and TCRBV repertoires soon after allogeneic hematopoietic cell transplantation in virtually all tested recipients. 1 Furthermore, we demonstrated that reconstitution of the ␣ T cell, but not the ␥␦ T cell repertoire was incomplete for at least 2 months after transplantation, and that the delayed reconstitution of TCR repertoire diversity was more profound in immunocompro- mised hosts. 2,3 We also found that TCR usage appears to be limited, and that amino acid sequences frequently contain an arginine residue followed by acidic amino acid residues in the complementarity-determining region 3 (CDR3) of TCR- chains containing BV24S1, suggesting that skewing of the TCRAV and TCRBV repertoires is antigen-driven. 1 These features of post-transplant T cell regeneration are similar to those during extrathymic differentiation of T cell progenitors and peripheral expansion of mature T cell populations, which have been demonstrated by murine bone marrow transplantation studies. 4 Extrathymic differentiation of T cell progeny in bone marrow generates TCR␥␦ ϩ and CD4 Ϫ CD8 Ϫ TCR␣ ϩ T cells. 5,6 Peripheral expansion of mature T lymphocytes is driven by the antigenic milieu of the host 7,8 and gives rise to substantial numbers of TCR␣ ϩ CD4 ϩ and TCR␣ ϩ CD8 ϩ T cells. 5,9 However, an infusion of a limited number of T cells into athymic mice results in skewed TCR repertoires. 5 Clonal expansion of T lymphocytes is the principal mechanism of antigen-specific immune responses. 10,11 The CDR3 regions of TCRBV and TCRAV make the principal contact with an antigenic peptide that is bound to the major histocompatibility complex (MHC) and the...