Low B cell counts as risk factor for infectious complications in systemic sclerosis after autologous hematopoietic stem cell transplantation

Abstract

Background: Autologous hematopoietic stem cell transplantation (aHSCT) is a treatment option for a selected group of systemic sclerosis (SSc) patients with good available evidence but can be associated with considerable morbidity and mortality. The aim of this study was to describe infectious complications and distinct immune reconstitution patterns after aHSCT and to detect risk factors in lymphocyte subsets, which are associated with an elevated rate of infections after aHSCT. Methods: Seventeen patients with SSc were included in this single-center retrospective cohort study. Clinical and laboratory data was collected before and for 12 months after aHSCT, including immunophenotyping of peripheral whole blood by fluorescence-activated cell sorting. Results: Cytomegalovirus (CMV) reactivations were common in CMV-IgG-positive patients (50%) and needed treatment. Mycotic infections occurred in 17.6%. One patient died (resulting in a mortality of 5.9%) due to pneumonia with consecutive sepsis. All patients showed decreased T helper cells (CD3 + /CD4 +) and within the B cell compartment decreased post-switched memory B cells (CD19 + /CD27 + /IgD −) and elevated naïve B cells (CD19 + / CD27 − /IgD +) until 12 months after aHSCT. Patients who developed infections had significantly lower B cells before aHSCT than patients who did not develop infections. Conclusion: After aHSCT, monitoring for infectious complications, especially for CMV reactivations, is crucial as the reconstitution of the immune system takes longer than 12 months. Low peripheral B cells might be a risk factor for an elevated infection rate.

Latent Cytomegalovirus Reactivation in Patients With Liver Failure: A 10-Year Retrospective Case-Control Study, 2011-2020

“…The results were plausible, because CD8 + T cells play a major role in the control of CMV viremia ( Attaf et al., 2020 ). A previous study showed that patients with low B cell counts before HSCT might be at a risk of developing infections ( Gernert et al., 2020 ). Sepsis non-survivors exhibited reduced B cell numbers at the onset of sepsis, compared to sepsis survivors ( Krautz et al., 2018 ).…”

Immunosuppressive Therapy After Autologous Hematopoietic Stem Cell Transplantation in Systemic Sclerosis Patients—High Efficacy of Rituximab

“…Patients were treated according to the ASTIS trial protocol ( 12 ) with modifications as previously described ( 15 , 16 ): 2 g/m 2 cyclophosphamide with at least 105 µg granulocyte-colony stimulating factor daily from day 2 after cyclophosphamide was given for mobilization of autologous hematopoietic stem cells. Leukapheresis followed.…”

High Prevalence of Genital Human Papillomavirus Infection in Patients With Primary Immunodeficiencies

“…Peripheral blood was collected in EDTA tubes and directly processed. Fluorescence-activated cell sorting (FACS) was performed as formerly described ( 21 , 22 ). Of each antibody 10 µl were used and incubated for 15 minutes at room temperature.…”