Higher Infused Lymphocyte Counts Improve Antibody Response to Immunization After Autologous Stem Cell Transplantation
Infectious diseases remain a leading cause of morbidity and mortality in patients who
receive high-dose chemotherapy followed by Autologous Peripheral Blood Stem Cell
Transplantation (APBSCT). Infectious disease complications of transplantation might be
reduced by effective post-transplant immunization but reconstitution of the immune system
may take months to years after transplantation and responses to immunization are often
attenuated in this setting. Correlates of improved immune reconstitution and response to
immunization after transplantation would be important to identify. It has been recently
shown that higher absolute lymphocyte count in the infused stem cell autograft (A-ALC) and
higher ALC at day +15 after stem cell infusion (ALC-15) are independently associated with
improved overall survival after APBSCT. The mechanism of this association is unclear, but
this finding suggests that improved immune responses to immunization might also be achieved
with this approach making it possible to immunize at 6 months instead of at one year. This
hypothesis has never been evaluated.
Survival following APBSCT is improved with a higher A-ALC and ALC-15. It is postulated that
the higher lymphocyte numbers correlate with improved immune surveillance and destruction of
minimal residual disease. Thus, one must consider the probability higher A-ALC will confer
improved response to T-cell dependent immunization early after transplant.
Observational Model: Cohort, Time Perspective: Prospective
To assess the antibody response to Prevnar® and its correlation to autograft absolute lymphocyte count (A-ALC).
Richard A Zuckerman, MD
Dartmouth-Hitchcock Medical Center
United States: Institutional Review Board
|Dartmouth-Hitchcock Medical Center||Lebanon, New Hampshire 03756|