Mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients

Summary:We have examined the reconstitution of ␥␦ T cell repertoire diversity after human allogeneic hematopoietic cell transplantation using a polymerase chain reaction (PCR)-based complementarity-determining region (CDR) 3 size spectratyping and DNA sequencing. The CDR3 complexity in the variable region of the T cell receptor (TCR)-␦ chain was different amongst the individuals studied. Furthermore, CDR3 size distribution patterns of allogeneic hematopoietic cell transplant recipients were almost completely recovered by a few months after transplantation. In some patients, clonal predominance of the TCRDV1+ T cells became evident during the period after transplantation. In one particular donor/recipient pair, clonal predominance of TCRDV1+ T cells was already present in blood lymphocytes of the donor, and was also observed in the recipient after transplantation. Using this donor/recipient pair, we have questioned whether ␥␦ T cell regeneration occurs via the peripheral expansion of mature T cells in the graft. In the donor lymphocytes, two expanding ␥␦ T cell clones, which were demonstrated by CDR3 sequences of the TCR-␦ chain, were recognized. These two clones were identified in the T cells from the recipient post transplant, but not before transplantation. One of the two clones was still detectable 1. years after the transplant procedure. These results strongly suggest that peripheral expansion of mature T cells in the graft is the principal pathway of ␥␦ T cell regeneration after allogeneic hematopoietic cell transplantation in adults. Bone Marrow Transplantation (2000) 26, 177-185. Keywords: T cell receptor; ␦-chain; diversity; transplantation High-dose chemoradiotherapy depletes T cells in blood and marrow transplant recipients and adequate T cell regeneration is essential for successful transplantation. The repertoire of T cells requires to be sufficiently diverse in order to recognize a wide range of microorganism-derived antigens. ␣␤ T cells are almost exclusively thymus-dependent

Section: Discussionsupporting

confidence: 79%

Reconstitution of γδ T cell repertoire diversity after human allogeneic hematopoietic cell transplantation and the role of peripheral expansion of mature T cell population in the graft

Hirokawa

Horiuchi

Kawabata

et al. 2000

“…Tuberculosis after transplantation is a very rare infectious complication in the non-endemic area. [40][41][42] However, in endemic countries, high incidence up to 5% has been reported. 43,44 Although prevalence of tuberculosis has dramatically decreased nowadays, Korea is still a tuberculosis-endemic country.…”

Section: Discussionmentioning

confidence: 99%

Infectious complications and outcomes after allogeneic hematopoietic stem cell transplantation in Korea

Lee

Choi

et al. 2004

Summary:We reviewed 242 allogeneic hematopoietic stem cell transplantation (HSCT) recipients retrospectively over a 2-year period (January 1998-December 1999 in order to analyze the characteristics and assess the outcomes of infectious complications in patients after HSCT in Korea. Bacteria were the major pathogens before engraftment, and viral and fungal infections predominated during the post-engraftment period. Varicella zoster virus was the most common viral pathogen after engraftment. Cytomegalovirus disease occurred mainly in the late-recovery phase. The frequency of mold infection was higher than that of yeast. There was a relatively high incidence of tuberculosis (3.0%) and Pneumocystis carinii pneumonia (6.5%). One case of death by measles confirmed by autopsy was also noted. Overall, cumulative mortality was 43% (104/242), and 59.6% of these deaths (62/104) were infection-related. Allogeneic HSCT recipents from unrelated donors were prone to infectious complication and higher mortality than those from matched sibling (17/39 (43.6%) vs 45/203 (22.2%), respectively; Po0.01; odd ratio 2.5; 95% confidence interval 1.2-5.1). As infection was the main post-HSCT complication in our data, more attention should be given to the management of infections in HSCT recipients.

“…The majority of the studies have reported incidences varying from 0.1 to 2.2%, while only a single study from Hong Kong has reported a much higher incidence of tuberculosis close to 5%. [2][3][4]8,9 It is generally believed that an immunosuppressed state will magnify the infectious diseases that are endemic in a locality and since Asian countries have a higher incidence of tuberculosis, one would expect the incidence of tuberculosis to be higher in such populations.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis among allogeneic bone marrow transplant recipients in India

George

Mathews

Srivastava

et al. 2001

Summary:Allogeneic bone marrow transplant recipients have severe impairment of cell-mediated immunity and hence a higher incidence of mycobacterial infections might be expected in regions where tuberculosis is common. We reviewed the case records of 217 patients who underwent allogeneic bone marrow transplantation during the period 1986-1999 at our center in India. Mycobacterial infections were diagnosed in three patients (1.38%). All patients presented with extrapulmonary disease. Two patients had disseminated tuberculosis with one of these being diagnosed on autopsy studies. The third patient had tuberculosis involving the cervical lymph node and dorsal spine. Two patients treated with antituberculous therapy are well. Infection with Mycobacterium tuberculosis is not a common problem in allogeneic bone marrow recipients even in an endemic area, but when it occurs, it is usually disseminated with predominantly extrapulmonary involvement. Bone Marrow Transplantation (2001) 27, 973-975.