Uher F, Puskás E, Torbágyi E, Barta A, Kormos L, Pálóczi K
Országos Hematológiai és Immunológiai Intézet, Budapest.
Orv Hetil. 2001 Jan 14;142(2):59-65.
After haematopoietic stem cell transplantation, reconstitution of bone marrow consists of two distinct phenomena, numerical recovery of bone marrow cellular elements on the one hand and functional recovery of cellular interactions on the other. Immune reactivity during the first month postgrafting is extremely low. Cytotoxic and phagocytic functions usually recover by day 100, while more specialized and cooperative functions of T and B cells remain impaired up to one year or more postgrafting. Regeneration of total CD4+ T cell number in adult (and especially in elderly) transplant recipients is severely limited and occurs largely by peripheral expansion of mature CD4+ T cells. While restoration of total CD8+ T cell number is commonly seen in adults, potentially important alterations in the subset composition of CD8+ populations remain. Contracted T cell repertoires for CD4+ and CD8+ T cells are consistently found in adults after T cell regeneration. This suggests that thymic function is frequently limiting in adults and that thymic-independent pathways are insufficient for restoring host immunocompetence. Although there are similarities in immune reconstitution after alllo- and autologous haematopoietic stem cell transplantations, allogeneic transplantation involves graft versus host disease and the use of immunosuppressive therapy to control it, both of which further interfere in the early developmental stages of immune reconstitution.
造血干细胞移植后，骨髓重建包括两种不同的现象，一方面是骨髓细胞成分的数量恢复，另一方面是细胞间相互作用的功能恢复。移植后第一个月的免疫反应性极低。细胞毒性和吞噬功能通常在第100天恢复，而T细胞和B细胞更特殊的协同功能在移植后长达一年或更长时间仍受损。成年（尤其是老年）移植受者中总CD4+T细胞数量的再生严重受限，主要通过成熟CD4+T细胞的外周扩增实现。虽然在成年人中通常可见总CD8+T细胞数量的恢复，但CD8+群体的亚群组成仍存在潜在的重要改变。在成年T细胞再生后，持续发现CD4+和CD8+T细胞的T细胞库收缩。这表明胸腺功能在成年人中常常受限，且非胸腺依赖途径不足以恢复宿主免疫能力。尽管异体和自体造血干细胞移植后的免疫重建存在相似之处，但异体移植涉及移植物抗宿主病以及使用免疫抑制疗法来控制该病，这两者都会进一步干扰免疫重建的早期发育阶段。
