Abstract
Objective To explore the clinical significance of the relationship between the immune function and the pathogenesis of aplastic anemia in children with aplastic anemia(AA), along with the incidence of graft versus host disease (GVHD) by monitoring the changes of T lymphocyte subsets dynamically in + 1, + 3, + 6, + 12 months for blood disease patients after allogeneic hematopoietic stem cell transplantation. Methods Twelve AA patients received allogeneic hematopoietic stem cell transplantation in Department of Hematology, the Affiliated General Hospital of Beijing Military Region of Anhui Medical University, from January 2013 to January 2014, including 4 male and 8 female, with average age of 7.92 years old(3-14 years old) with 5 cases of human leukocyte antigen(HLA) matched and 7 cases of HLA mismatched.The level of T lymphocyte subsets including CD3+ , CD4+ , CD8+ , CD4+ /CD8+ , CD56+, CD4+ CD25high+ FOXP3+ were monitored with flow cytometry before transplantation and in + 1, + 3, + 6, + 12 months after transplantation dynamically in the peripheral blood.While in the same period the level of T lymphocyte subsets was monitored in 12 cases of healthy children at the same period as the healthy control group. Results Followed up to March 2015, 10 cases had abnormal cellular immunity (CD4+ /CD8+ ratio inversion) in the 12 AA patients.Compared with the control group, in the AA group, CD3+ was slightly higher, (66.79±7.35)% and (62.74±5.58)% respectively(P=0.043), CD4+ was decreased by (33.73±7.26)% and (39.54±3.46)% respectively(P=0.037), CD8+ was increased by (35.69±6.78)% and (25.34±4.36)%, respectively (P=0.000), CD4+ /CD8+ decreased by 1.23±0.56 and 1.78±0.34 respectively(P=0.001) and CD56+ was decreased by (7.46±2.80)% and (16.73±3.70)% respectively(P=0.000), CD4+ CD25high+ FOXP3+ was decreased by (3.3±1.5)% and (8.1±1.3)% respectively (P=0.003), whose difference was statistically significant (P<0.05). The lever of CD3+ , CD4+ , CD8+ , CD4+ /CD8+ , CD56+, CD4+ CD25high+ FOXP3+ had a different degree of recovery after transplantation for all cases and returned to normal in + 12 months basically. In + 1, + 3, + 6, + 12 months after transplantation, the levels of CD4+ CD25high+ FOXP3+ in GVHD positive group and negative group were (0.4±0.6)% and (1.6±0.7)% respectively, (0.7±0.3)% and (2.7±0.4)% respectively, (1.1±0.5)% and (2.9±0.7)% respectively, (1.4±0.3)% and (3.6±0.2)% respectively, which had statistical significance (P<0.05). Conclusions There was abnormal cell immune function in some cases with AA.After transplantation, the level of CD4+ CD25high+ FOXP3+ is closely related to the acute GVHD, which can be used to predict the occurrence of GVHD. Key words: Aplastic anemia; Allogeneic hematopoietic stem cell transplantation; Cellular immune function; T lymphocyte subsets; Graft versus host disease
Published Version
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