Thymopoiesis following HSCT; a retrospective review comparing interventions for aGVHD in a pediatric cohort

Publication date: August 2018

Source: Clinical Immunology, Volume 193

Author(s): A.M. Flinn, C.F. Roberts, M.A. Slatter, R. Skinner, H. Robson, J. Lawrence, J. Guest, A.R. Gennery

Abstract

Acute graft-versus-host disease (aGVHD) complicates allogeneic hematopoietic stem cell transplantation (HSCT), and is treated with topical and/or systemic corticosteroids. Systemic corticosteroids and aGVHD damage thymic tissue. We compared thymopoietic effect of topical steroid therapy, corticosteroids and extracorporeal photopheresis (ECP) in 102 pediatric allogeneic HSCT patients.

We categorized patients into 4 groups: - no aGVHD, aGVHD treated with topical or systemic steroid, or ECP. Naïve CD4⁺ CD45RA⁺ CD27⁺ T-lymphocyte values at 3, 6, 9, 12 months post-HSCT were recorded: for ECP patients, values were recorded at 3, 6, 9, 12 months during ECP. Differences were compared using the Kruskal-Wallis test.

41 patients had no aGVHD, 23 had aGVHD treated topically or systemically (25), 13 received ECP. Rate of thymopoiesis was significantly different between all groups at all time-points post-transplant (p = 0.002, p < 0.001, p < 0.001, p = 0.001 respectively).

Even mild aGVHD impairs thymopoiesis. Worst recovery was in ECP patients. Earlier institution of ECP may speed thymic recovery.

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