Functional hyposplenism following allogeneic bone marrow transplantation.

Abstract

Ains-To investigate the incidence of functional hyposplenism in a group of patients who had undergone allogeneic bone marrow transplantation (BMT). Methods-Splenic function was assessed by counting the number of gluteraldehyde fixed red blood cells containing pits or indentations as examined by interference phase microscopy. Normal values are <2% whereas splenectomy patients have values of 25 to 40%. Results-Twenty eight BMT recipients (17 men, 11 women) were studied at varying periods post-transplant and the results compared with 20 healthy volunteers and 10 patients who had undergone splenectomy or had splenic atrophy because of haematological conditions. Ofthe 28 BMT recipients, one had undergone a prior splenectomy; ofthe remaining 27 patients, four (15%) had evidence of functional hyposplenism with between 5 0 and 34 0% pitted cells. Of these four patients, one had active extensive chronic graft versus host disease (GvHD) which has been previously reported to be associated with functional hyposplenism following transplantation. Only one of the four patients had peripheral blood red cell changes typical of hyposplenism. Conclusion-These results confirm that extensive chronic GvHD is associated with hyposplenism. Intermediate degrees of functional hyposplenism may also occur following BMT in the absence of chronic GvHD and in the absence of haematological features of hyposplenism on routine blood films. This may be of significance in mediating the susceptibility to infection with encapsulating bacteria seen following allogeneic BMT. (J Clin Pathol 1995;48:257-259)

Significant differences in B-cell subpopulations characterize patients with chronic graft-versus-host disease–associated dysgammaglobulinemia

“…11,14,15,[24][25][26][27] We recently observed a significant distortion of B-cell homeostasis seen in significant elevation of CD19 ϩ CD21 low immature B cells and deficiency of CD19 ϩ CD27 ϩ memory B cells in patients with active cGVHD. 14 Because other hallmarks of affection of the patients' immune system by cGVHD are hypogammaglobulinemia 20,28,29 and functional hyposplenism, which can occur in up to 15% of HCT patients 21,30 on the one hand and hypergammaglobulinemia 31,32 and presence of autoantibodies at onset and related to activity of cGVHD on the other hand, 20,33,34 we analyzed different cGVHD patient cohorts defined by serum Ig levels as surrogate markers for B-cell function. We observed in cGVHD patients with hypogammaglobulinemia a significant CD19 ϩ B-cell deficiency with significantly higher CD19 ϩ CD21 low immature B-cell proportions, significantly higher CD19 ϩ CD21 int-high CD38 high IgM high transitional B-cell proportions, significantly lower CD19 ϩ CD10 Ϫ CD27 Ϫ CD21 high naive B cells and significantly lower CD19 ϩ CD27 ϩ IgD ϩ non-classswitched and CD19 ϩ CD27 ϩ IgD Ϫ class-switched memory B cells compared with cGVHD patients with hypergammaglobulinemia or normogammaglobulinemia.…”

Optimal management of chronic graft‐versus‐host disease in children

“…Briefly, antibacterial prophylaxis for encapsulated organisms (penicillin VK preferred) is necessary for all patients with chronic GVHD receiving immunosuppression (Kulkarni et al, 2000). Some centres will continue penicillin long-term given the functional hyposplenism that persists in chronic GVHD patients (Cuthbert et al, 1995). P. jirovecii prophylaxis is necessary (trimethoprim-sulfamethoxazole, pentamidine, dapsone) in chronic GVHD patients receiving systemic immunosuppression (Souza et al, 1999).…”

Spleen sizing by ultrasound scan and risk of pneumococcal infection in patients with chronic GVHD: preliminary observations

“…19 In this study we used ultrasound (US) scan to evaluate spleen size in bone marrow transplant patients and correlated spleen size with the occurrence of cGVHD and of EBI.…”