Thymic hyperplasia after autologous hematopoietic stem cell transplantation in multiple sclerosis: a case series
IntroductionReactivation of thymopoiesis in adult patients with autoimmune disorders treated with autologous haematopoietic stem cell transplantation (AHSCT) is supported by studies exploring immunoreconstitution. Radiological evidence of thymic hyperplasia after AHSCT was previously reported in pat...
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Frontiers Media S.A.
2024-11-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1478777/full |
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| author | Alice Mariottini Alice Mariottini Riccardo Boncompagni Diletta Cozzi Edoardo Simonetti Anna Maria Repice Valentina Damato Valentina Damato Mirella Giordano Vittorio Miele Chiara Nozzoli Luca Massacesi Luca Massacesi |
| author_facet | Alice Mariottini Alice Mariottini Riccardo Boncompagni Diletta Cozzi Edoardo Simonetti Anna Maria Repice Valentina Damato Valentina Damato Mirella Giordano Vittorio Miele Chiara Nozzoli Luca Massacesi Luca Massacesi |
| author_sort | Alice Mariottini |
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| description | IntroductionReactivation of thymopoiesis in adult patients with autoimmune disorders treated with autologous haematopoietic stem cell transplantation (AHSCT) is supported by studies exploring immunoreconstitution. Radiological evidence of thymic hyperplasia after AHSCT was previously reported in patients with systemic sclerosis, but, to our knowledge, it has not been described in multiple sclerosis (MS), where premature thymic involution has been observed and immunosenescence might be accelerated by disease-modifying treatments (DMTs).Participants and methodsmonocentric case series including MS patients who performed a chest CT scan for clinical purposes after having received AHSCT (BEAM/ATG regimen) for aggressive MS failing DMTs. Chest CT exams were reviewed by a thoracic radiologist: thymic hyperplasia was defined as a rounded mass in the thymic loggia with a density around 40 Hounsfield Units (HU) and thickness >1.3 cm.ResultsFifteen MS patients were included; the median time interval between AHSCT and chest CT scan was 2 (range 1-18) months. All the patients were free from new inflammatory events and DMTs over a median follow-up of 36 months (range 12-84) after AHSCT. Thymic hyperplasia was detected in 3/15 (20%) cases in an exam taken 1 to 3 months after AHSCT; all these patients were females, and aged 30 to 40 years. Lung infections and secondary autoimmunity were diagnosed in 5 and 1 cases, respectively, none of which showed thymic hyperplasia. No associations between thymic hyperplasia and clinical-demographic characteristics or post-AHSCT outcomes were observed.ConclusionsThymic hyperplasia was detected in 20% of MS patients recently treated with AHSCT. These results are consistent with previous immunological studies showing that AHSCT promotes thymus reactivation in MS patients, further supporting de-novo thymopoiesis as a cornerstone of immune reconstitution after AHSCT in this population. |
| format | Article |
| id | doaj-art-7e0f152fbd394c60a5b391d049574e92 |
| institution | OA Journals |
| issn | 1664-3224 |
| language | English |
| publishDate | 2024-11-01 |
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| series | Frontiers in Immunology |
| spelling | doaj-art-7e0f152fbd394c60a5b391d049574e922025-08-20T02:22:34ZengFrontiers Media S.A.Frontiers in Immunology1664-32242024-11-011510.3389/fimmu.2024.14787771478777Thymic hyperplasia after autologous hematopoietic stem cell transplantation in multiple sclerosis: a case seriesAlice Mariottini0Alice Mariottini1Riccardo Boncompagni2Diletta Cozzi3Edoardo Simonetti4Anna Maria Repice5Valentina Damato6Valentina Damato7Mirella Giordano8Vittorio Miele9Chiara Nozzoli10Luca Massacesi11Luca Massacesi12Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, ItalyNeurology II Department, University Hospital Careggi, Florence, ItalyCell Therapy and Transfusion Medicine Unit, University Hospital Careggi, Florence, ItalyDepartment of Emergency Radiology, University Hospital Careggi, Florence, ItalyCell Therapy and Transfusion Medicine Unit, University Hospital Careggi, Florence, ItalyNeurology II Department, University Hospital Careggi, Florence, ItalyDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, ItalyNeurology II Department, University Hospital Careggi, Florence, ItalyCell Therapy and Transfusion Medicine Unit, University Hospital Careggi, Florence, ItalyDepartment of Emergency Radiology, University Hospital Careggi, Florence, ItalyCell Therapy and Transfusion Medicine Unit, University Hospital Careggi, Florence, ItalyDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, ItalyNeurology II Department, University Hospital Careggi, Florence, ItalyIntroductionReactivation of thymopoiesis in adult patients with autoimmune disorders treated with autologous haematopoietic stem cell transplantation (AHSCT) is supported by studies exploring immunoreconstitution. Radiological evidence of thymic hyperplasia after AHSCT was previously reported in patients with systemic sclerosis, but, to our knowledge, it has not been described in multiple sclerosis (MS), where premature thymic involution has been observed and immunosenescence might be accelerated by disease-modifying treatments (DMTs).Participants and methodsmonocentric case series including MS patients who performed a chest CT scan for clinical purposes after having received AHSCT (BEAM/ATG regimen) for aggressive MS failing DMTs. Chest CT exams were reviewed by a thoracic radiologist: thymic hyperplasia was defined as a rounded mass in the thymic loggia with a density around 40 Hounsfield Units (HU) and thickness >1.3 cm.ResultsFifteen MS patients were included; the median time interval between AHSCT and chest CT scan was 2 (range 1-18) months. All the patients were free from new inflammatory events and DMTs over a median follow-up of 36 months (range 12-84) after AHSCT. Thymic hyperplasia was detected in 3/15 (20%) cases in an exam taken 1 to 3 months after AHSCT; all these patients were females, and aged 30 to 40 years. Lung infections and secondary autoimmunity were diagnosed in 5 and 1 cases, respectively, none of which showed thymic hyperplasia. No associations between thymic hyperplasia and clinical-demographic characteristics or post-AHSCT outcomes were observed.ConclusionsThymic hyperplasia was detected in 20% of MS patients recently treated with AHSCT. These results are consistent with previous immunological studies showing that AHSCT promotes thymus reactivation in MS patients, further supporting de-novo thymopoiesis as a cornerstone of immune reconstitution after AHSCT in this population.https://www.frontiersin.org/articles/10.3389/fimmu.2024.1478777/fullmultiple sclerosishematopoietic stem cell transplantationtransplantthymusimmune reconstitutionautoimmune diseases |
| spellingShingle | Alice Mariottini Alice Mariottini Riccardo Boncompagni Diletta Cozzi Edoardo Simonetti Anna Maria Repice Valentina Damato Valentina Damato Mirella Giordano Vittorio Miele Chiara Nozzoli Luca Massacesi Luca Massacesi Thymic hyperplasia after autologous hematopoietic stem cell transplantation in multiple sclerosis: a case series Frontiers in Immunology multiple sclerosis hematopoietic stem cell transplantation transplant thymus immune reconstitution autoimmune diseases |
| title | Thymic hyperplasia after autologous hematopoietic stem cell transplantation in multiple sclerosis: a case series |
| title_full | Thymic hyperplasia after autologous hematopoietic stem cell transplantation in multiple sclerosis: a case series |
| title_fullStr | Thymic hyperplasia after autologous hematopoietic stem cell transplantation in multiple sclerosis: a case series |
| title_full_unstemmed | Thymic hyperplasia after autologous hematopoietic stem cell transplantation in multiple sclerosis: a case series |
| title_short | Thymic hyperplasia after autologous hematopoietic stem cell transplantation in multiple sclerosis: a case series |
| title_sort | thymic hyperplasia after autologous hematopoietic stem cell transplantation in multiple sclerosis a case series |
| topic | multiple sclerosis hematopoietic stem cell transplantation transplant thymus immune reconstitution autoimmune diseases |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1478777/full |
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