HEMO 2025 / III Simpósio Brasileiro de Citometria de Fluxo
Mais dadosCD4+ and CD8+ lymphocytes regenerate within the first year after Bone Marrow Transplant (BMT). The survival and peripheral expansion of donor memory T-cells transfused with the graft is the dominant mechanism in the first year after the BMT, with the predominant expansion of TCD8+ cells. This explains the inverted CD4/CD8 ratio detected in post-BMT patients. That is the reason why it is not a surprise to find elevated TCD8 cells in an immune profile of a patient submitted to bone marrow transplant. However, post-transplant patients are prone to viral infections, and CD8 T cells display unique profiles depending on their viral specificity: Cells are predominantly CCR7+ CD27+ CD28+ during latent infection with HCV, CCR7(-) CD27+ CD28+ in EBV, CCR7(-) CD27+ CD28(-) in HIV, and CCR7(-) CD27(-) CD28(-) in CMV.
ReportFemale patient, 25 years old, Previous diagnosis of B-Acute Lymphoid leukemia, D+180 after bone marrow transplantation, post-stem cell transplant immune profile, with progressive lymphocytosis, Peripheral blood sample with white blood count 6,900 cells.
Results58% T Cells (4/8 = 0.2): *46.2% TCD8+ TCRCBeta1+36% (polyclonal) 21.75% TD phenotype with increased absolute levels (1501 cells/μL - normal age range 1-384) CD45RA+ CD27(-), 21.45% EM phenotype with increased absolute levels (1480 cells/μL - normal age range 5-69) CD45RA(-) CD27(-), 0.2% Naive CD45RA+ CD27+, 2.8% CM/TM CD45RA(-) CD27+; *9.8% TCD4+ TCRCBeta1+36,5% (polyclonal) 0.6% Naive CD45RA+ CD27+, 2.5% CM/TM CD45RA(-) CD27+, 0.1% TD CD45RA+ CD27(-, 6.6% EM CD45RA(-) CD27+ (Fig. 1).
Conclusionperipheral blood sample showing a relative (58%) and absolute (4,005/mm3) increase in mature (CD3+) T lymphoid cells (CD45++), with a predominant phenotype (42%) of polyclonal effector (terminally differentiated) CD8+ T cells / memory effector cells (CD27(-) CD28(-) CCR7(-) CD45RA+/- CD45RO-/+), with negative CCR7/CD27/CD28 expression, a phenotype suggestive of viral infection, most likely CMV, later confirmed with serologic tests.
References:
- 1.
Purnama C, Camous X, Larbi A. An overview of T cell subsets and their potential use as markers of immunological ageing. Int Trends Immunity. 2013;1:21-32.
- 2.
Mahnke YD, Brodie TM, Sallusto F, Roederer M, Lugli E. The who's who of T‐cell differentiation: human memory T‐cell subsets. Eur J Immunol. 2013;43(11):2797-809.
- 3.
van der Burg M, Kalina T, Perez-Andres M, Vlkova M, Lopez-Granados E, Blanco E, et al. The EuroFlow PID orientation tube for flow cytometric diagnostic screening of primary immunodeficiencies of the lymphoid system. Front Immunol. 2019;10:246.
- 4.
Ogonek J, Juric MK, Ghimire S, Varanasi PR, Holler E, Greinix H, et al. Immune reconstitution after allogeneic hematopoietic stem cell transplantation. Front Immunol. 2016;7:507.
- 5.
Shi M, Jevremovic D, Otteson GE, Timm MM, Olteanu H, Horna P, et al. Single antibody detection of T‐cell receptor αβ clonality by flow cytometry rapidly identifies mature T‐cell neoplasms and monotypic small CD8‐positive subsets of uncertain significance. Cytometry B Clin Cytom. 2020;98:99-107.
- 6.
Horna P, Shi M, Jevremovic D, Craig FE, Comfere NI, Olteanu H, et al. Utility of TRBC1 expression in the diagnosis of peripheral blood involvement by cutaneous T-cell lymphoma. J Invest Dermatol. 2021;141:821-829.e2.
Figure 1 Normal double-negative Gamma/Delta cells in purple; normal TCD4+ cells in green; normal TCD8+ cells in dark blue; TD CD8+ cells in turquoise.
