Takaue Y, Okamoto Y, Kawano Y, Suzue T, Abe T, Saito S I, Sato J, Hirao A, Makimoto A, Kawahito M
Department of Pediatrics, University Hospital of Tokushima, Japan.
Bone Marrow Transplant. 1994 Aug;14(2):219-23.
We assessed recovery of the immune system in 41 children who underwent high-dose chemotherapy (without total body irradiation) and autologous peripheral blood stem cell transplantation (PBSCT) for acute leukemias or non-Hodgkin's lymphoma. The analysis was in two parts. Firstly, we performed serial monitoring of regenerating subsets and blastogenesis of lymphocytes. We then reviewed the incidence of varicella-zoster virus (VZV) infection, based on the belief that this served as a clinical indication of immunological recovery. The CD4/CD8 ratio markedly decreased in all patients, with a nadir at 3 months, due to both abnormally low levels of CD4+ cells and sustained higher levels of CD8+ cells. These abnormalities were sustained for > 12 months post-graft. Within 6 months after PBSCT, all patients showed a decreased in vitro response to mitogens including PHA, Con A and PWM but these responses gradually recovered during the subsequent 6 months. All patients had a previous history of chicken pox. The actuarial incidence of VZV was 45% at 6 months and 67% at 12 months. All patients were treated with intravenous acyclovir with relief of pain and cutaneous healing within 10 days. No patient developed visceral dissemination. These findings suggest that at least in children, no major difference is apparent between immunological reconstitution in bone marrow transplantation and PBSCT. The development of minor and reversible VZV is a common event in this group of patients.
我们评估了41名接受大剂量化疗（无全身照射）及自体外周血干细胞移植（PBSCT）治疗急性白血病或非霍奇金淋巴瘤的儿童免疫系统的恢复情况。分析分为两部分。首先，我们对淋巴细胞再生亚群和母细胞生成进行了系列监测。然后，基于水痘带状疱疹病毒（VZV）感染的发生率可作为免疫恢复的临床指标这一观点，我们回顾了VZV感染的发生率。由于CD4+细胞水平异常低且CD8+细胞水平持续较高，所有患者的CD4/CD8比值均显著下降，在3个月时降至最低点。这些异常在移植后持续超过12个月。在PBSCT后6个月内，所有患者对包括PHA、Con A和PWM在内的丝裂原的体外反应均降低，但在随后的6个月内这些反应逐渐恢复。所有患者既往均有水痘病史。VZV的精算发病率在6个月时为45%，在12个月时为67%。所有患者均接受静脉注射阿昔洛韦治疗，疼痛缓解，皮肤在10天内愈合。无患者发生内脏播散。这些发现表明，至少在儿童中，骨髓移植和PBSCT的免疫重建之间没有明显差异。轻微且可逆的VZV的发生在该组患者中是常见事件。
