4.5 Review

Clinical strategies to enhance thymic recovery after allogeneic hematopoietic stem cell transplantation

Journal

IMMUNOLOGY LETTERS
Volume 155, Issue 1-2, Pages 31-35

Publisher

ELSEVIER SCIENCE BV
DOI: 10.1016/j.imlet.2013.09.016

Keywords

Immune regeneration; Thymus; Allogeneic hematopoietic stem cell transplantation

Categories

Funding

  1. National Institutes of Health [R01-HL069929, R0-1A1100288, R01-A1080455, R01-A1101406, P01-CA023766, 1K99CA176376]
  2. U.S National Institute of Allergy and Infectious Diseases (NIAID) [HHSN272200900059C]
  3. Lymphoma Foundation
  4. Alex's Lemonade Stand
  5. Geoffrey Beene Cancer Research Center at MSKCC
  6. Susan and Peter Solomon Divisional Genomics Program
  7. Italian Foundation for Cancer Research
  8. Italian Society of Pharmacology
  9. American Society for Blood and Marrow Transplantation
  10. Cancer Council of Victoria (Australia)
  11. Leukemia and Lymphoma Society
  12. Australian National Health and Medical Research Council
  13. American Society of Hematology
  14. Associazione Italiana per la Ricerca sul Cancro Funding Source: Custom

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The thymus is particularly sensitive to injury caused by cytoreductive chemo- or radiation therapy, shock, infection and graft versus host disease. Insufficient thymic recovery has been directly correlated with increased risk of opportunistic infections and poor clinical outcomes in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Prolonged immune deficiency is particularly pronounced in older patients whose thymi are already significantly impaired due to age-related thymic involution. Preclinical and clinical studies have revealed several strategies that can enhance thymic function and immune reconstitution after transplant, including sex steroid ablation, growth factors (growth hormone, keratinocyte growth factor, insulin-like growth factor 1, interleukin-7) and ex vivo generated precursor T cells. In addition, recent studies have shown that other approaches, such as interleukein-22 and nutritional changes, may represent additional candidates to enhance thymic regeneration. In this review we provide updates on these strategies and comment on their potential to be translated into clinical therapies. (C) 2013 Elsevier B.V. All rights reserved.

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