CMV seronegative donors: Effect on clinical severity of CMV infection and reconstitution of CMV-specific immunity

Transpl Immunol. 2018 Aug:49:54-58. doi: 10.1016/j.trim.2018.04.003. Epub 2018 Apr 18.

Abstract

Background: Cytomegalovirus (CMV)-specific T-cells are crucial to prevent CMV disease. CMV seropositive recipients transplanted with stem cells from a CMV seronegative allogeneic donor (R+D-) may be at risk for CMV disease due to absence of donor CMV-specific memory T-cells in the graft.

Methods: We analyzed the duration of CMV reactivations and the incidence of CMV disease in R+D- and R+D+ patients after alemtuzumab-based T-cell depleted allogeneic stem cell transplantation (TCD alloSCT). To determine the presence of donor-derived primary CMV-specific T-cell responses we analyzed the origin of CMV-specific T-cells in R+D- patients.

Results: The duration of CMV reactivations (54 versus 38 days, respectively, p = 0.048) and the incidence of CMV disease (0.14 versus 0.02, p = 0.003 at 1 year after alloSCT) were higher in R+D- patients compared to R+D+ patients. In R+D- patients, CMV-specific CD4+ and CD8+ T-cells were mainly of recipient origin. However, in 53% of R+D- patients donor-derived CMV-specific T-cells were detected within the first year.

Conclusions: In R+D- patients, immunity against CMV was predominantly mediated by recipient T-cells. Nevertheless, donor CMV serostatus significantly influenced the clinical severity of CMV reactivations indicating the role of CMV-specific memory T-cells transferred with the graft, despite the ultimate formation of primary donor-derived CMV-specific T-cell responses in R+D- patients.

Keywords: Alemtuzumab; Allogeneic transplantation; Cell separation; Chimerism; Cytomegalovirus infections; Flow cytometry; Stem cell transplantation; T-lymphocytes.

MeSH terms

  • Alemtuzumab / therapeutic use
  • Antibodies, Viral / blood*
  • Cytomegalovirus / physiology*
  • Cytomegalovirus Infections / immunology*
  • Female
  • Humans
  • Immunity
  • Immunologic Memory
  • Lymphocyte Depletion
  • Male
  • Middle Aged
  • Stem Cell Transplantation*
  • T-Lymphocytes / drug effects
  • T-Lymphocytes / physiology*
  • Tissue Donors
  • Transplantation Conditioning
  • Transplantation, Homologous
  • Virus Activation

Substances

  • Antibodies, Viral
  • Alemtuzumab