Recovery from and consequences of severe iatrogenic lymphopenia (induced to treat autoimmune diseases)

Jan Storek, Zhao Zhao, Eugene Lin, Thomas Berger, Peter A. McSweeney, Richard A. Nash, Yoshiki Akatsuka, Monja D. Metcalf, Hailing Lu, Tomas Kalina, Markus Reindl, Rainer Storb, John A. Hansen, Keith M. Sullivan, George H. Kraft, Daniel E. Furst, David G. Maloney

Research output: Contribution to journalArticlepeer-review

55 Citations (Scopus)


To ascertain the consequences of severe leukopenia and the tempo of recovery, we studied the immunity of 56 adult patients treated for multiple sclerosis or systemic sclerosis with autologous CD34 cell transplantation using extremely lymphoablative conditioning. NK cell, monocyte, and neutrophil counts recovered to normal by 1 month; dendritic cell and B cell counts by 6 months; and T cell counts by 2 years posttransplant, although CD4 T cell counts remained borderline low. Initial peripheral expansion was robust for CD8 T cells but only moderate for CD4 T cells. Subsequent thymopoiesis was slow, especially in older patients. Importantly, levels of antibodies, including autoantibodies, did not drop substantially. Infections were frequent during the first 6 months, when all immune cells were deficient, and surprisingly rare (0.21 per patient year) at 7-24 months posttransplant, when only T cells (particularly CD4 T cells) were deficient. In conclusion, peripheral expansion of CD8 but not CD4 T cells is highly efficient. Prolonged CD4 lymphopenia is associated with relatively few infections, possibly due to antibodies produced by persisting pretransplant plasma cells.

Original languageEnglish
Pages (from-to)285-298
Number of pages14
JournalClinical Immunology
Issue number3
Publication statusPublished - 12-2004
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology


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