Diagnostic Immunology Testing for the Hematologist
Assessing immune reconstitution and immune competence post-hematopoietic cell transplantation
Updated: December 2014
Published: December 2012
The Impact of Hematopoietic Cell Transplantation on the Immune System
Hematopoietic cell transplantation recalibrates every component of the hematopoietic system, in addition to resetting the clock on the immune system. Therefore, immunology testing is clinically and financially effective because it helps monitor the adequate numerical and functional recovery of the immune system.
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Why is Assessment of Immune Reconstitution and Immune Competence post-Hematopoietic Cell Transplantation so Important?
A systematic process of evaluating immune recovery post-transplant will ensure appropriate and accurate interpretation of the laboratory and clinical data. Serial immune monitoring should include pretransplant (preconditioning, followed by predefined and regular posttransplant) immunological analyses, with a selection of tests relevant to time from transplant.
Immune monitoring is important to:
- Verify all components of the immune system (innate and adaptive) are effectively reconstituted (numerically and functionally) within an expected time interval. This determines successful immune competence and impacts long-term outcomes such as infection susceptibility and adequate tumor surveillance.
- Identify individuals at higher risk for cytomegalovirus primary infection or reactivation and Epstein-Barr virus (EBV)-associated B-cell posttransplantation lymphoproliferative disorder and assess impact of adoptive immunotherapy or preemptive or prophylactic treatment.
- Determine a personalized schedule for posttransplant vaccination based on an individual patient’s immune competence and reconstitution profile rather than a universal (one size fits all) and empirical protocol and ensure competent postvaccination response to vaccines.
- Identify markers associated with acute or chronic graft-versus-host disease (GVHD) and response to treatment for GVHD.
- Assess successful immune competence in correlation to maintenance of remission (for malignancies or autoimmunity) or correction of original defect for primary immunodeficiencies.
- Potentially identify markers associated with long-term graft failure or incomplete immune recovery.