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Immune Reconstitution Following Stem Cell Transplant

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Basics of Hematopoietic Stem Cell Transplant

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Abstract

Immune reconstitution refers to the recovery of different immune cells post stem cell transplant (SCT). It is important for immune system to reconstitute following SCT because impaired or delayed immune system is associated with increased risk of infections, autoimmune manifestations, graft-versus-host disease (GVHD) and increased risk of relapse of hematological malignancies. For a transplant physician It is important to understand the mechanisms involved in the T cell recovery after SCT as these T cells are involved both in favorable (fighting infection and mediating GVL effect) and unfavorable (GVHD, autoimmunity) effects of transplant. T cell recovery post SCT is depends upon combined effect of the multiple factors. Following SCT, the thymus is subjected to damage by the conditioning regimens, corticosteroids, and post transplant immunosuppressive agents, leading to its impaired function. The methods to induce immunologic tolerance to a foreign antigen are based on the same principles that are involved in the tolerance to self-antigens. Immunosuppressive agents are used to suppress autoreactive, allo-aggressive, or hyper-inflammatory T cells. To regain the capability of responding to millions of environmental antigens post SCT the T cell compartment has to diversify enormously for which both thymic-dependent and thymic-independent pathways are needed. Immune reconstitution can be measured by monitoring the activity of cells of innate and adaptive immunity. Aging affects both T cells and B cells. This chapter highlights the basic questions which a transplant physician faces regarding the mechanisms behind the immune reconstitution after SCT. A thorough knowledge of T and B cell development is necessary to understand the principles of immune reconstitution.

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  1. Department of Hemato-oncology and Bone Marrow Transplantation, Venkateshwar Hospital, New Delhi, Delhi, India

    Sanjeev Kumar Sharma

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Sharma, S.K. (2023). Immune Reconstitution Following Stem Cell Transplant. In: Basics of Hematopoietic Stem Cell Transplant. Springer, Singapore. https://doi.org/10.1007/978-981-19-5802-1_35

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  • DOI: https://doi.org/10.1007/978-981-19-5802-1_35

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