Mariottini Alice, Boncompagni Riccardo, Cozzi Diletta, Simonetti Edoardo, Repice Anna Maria, Damato Valentina, Giordano Mirella, Miele Vittorio, Nozzoli Chiara, Massacesi Luca
Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
Neurology II Department, University Hospital Careggi, Florence, Italy.
Front Immunol. 2024 Nov 25;15:1478777. doi: 10.3389/fimmu.2024.1478777. eCollection 2024.
Reactivation of thymopoiesis in adult patients with autoimmune disorders treated with autologous haematopoietic stem cell transplantation (AHSCT) is supported by studies exploring immunoreconstitution. Radiological evidence of thymic hyperplasia after AHSCT was previously reported in patients with systemic sclerosis, but, to our knowledge, it has not been described in multiple sclerosis (MS), where premature thymic involution has been observed and immunosenescence might be accelerated by disease-modifying treatments (DMTs).
monocentric case series including MS patients who performed a chest CT scan for clinical purposes after having received AHSCT (BEAM/ATG regimen) for aggressive MS failing DMTs. Chest CT exams were reviewed by a thoracic radiologist: thymic hyperplasia was defined as a rounded mass in the thymic loggia with a density around 40 Hounsfield Units (HU) and thickness >1.3 cm.
Fifteen MS patients were included; the median time interval between AHSCT and chest CT scan was 2 (range 1-18) months. All the patients were free from new inflammatory events and DMTs over a median follow-up of 36 months (range 12-84) after AHSCT. Thymic hyperplasia was detected in 3/15 (20%) cases in an exam taken 1 to 3 months after AHSCT; all these patients were females, and aged 30 to 40 years. Lung infections and secondary autoimmunity were diagnosed in 5 and 1 cases, respectively, none of which showed thymic hyperplasia. No associations between thymic hyperplasia and clinical-demographic characteristics or post-AHSCT outcomes were observed.
Thymic hyperplasia was detected in 20% of MS patients recently treated with AHSCT. These results are consistent with previous immunological studies showing that AHSCT promotes thymus reactivation in MS patients, further supporting thymopoiesis as a cornerstone of immune reconstitution after AHSCT in this population.
探索免疫重建的研究支持了接受自体造血干细胞移植（AHSCT）治疗的成年自身免疫性疾病患者胸腺生成的重新激活。此前有报道称，系统性硬化症患者在AHSCT后出现胸腺增生的影像学证据，但据我们所知，在多发性硬化症（MS）中尚未有相关描述，MS患者存在胸腺过早退化的情况，且疾病修正治疗（DMTs）可能会加速免疫衰老。
单中心病例系列研究，纳入因DMTs治疗无效的侵袭性MS接受AHSCT（BEAM/ATG方案）后出于临床目的进行胸部CT扫描的MS患者。胸部CT检查由一位胸放射科医生进行评估：胸腺增生定义为胸腺区域内的圆形肿块，密度约为40亨氏单位（HU），厚度>1.3厘米。
纳入15例MS患者；AHSCT与胸部CT扫描之间的中位时间间隔为2（范围1 - 18）个月。在AHSCT后的中位随访36个月（范围12 - 84个月）期间，所有患者均无新的炎症事件且未接受DMTs治疗。在AHSCT后1至3个月进行的一次检查中，15例患者中有3例（20%）检测到胸腺增生；所有这些患者均为女性，年龄在30至40岁之间。分别有5例和1例被诊断为肺部感染和继发性自身免疫性疾病，其中均未出现胸腺增生。未观察到胸腺增生与临床人口统计学特征或AHSCT后结局之间的关联。
在近期接受AHSCT治疗的MS患者中，20%检测到胸腺增生。这些结果与先前的免疫学研究一致，表明AHSCT可促进MS患者的胸腺重新激活，进一步支持胸腺生成作为该人群AHSCT后免疫重建的基石。
