T‐cell dynamics after high‐dose chemotherapy in adults: elucidation of the elusive CD8+ subset reveals multiple homeostatic T‐cell compartments with distinct implications for immune competence

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Abstract
Summary: Recovery of total T cell numbers after in vivo T‐cell depletion in humans is accompanied by complex perturbation within the CD8+ subset. We aimed to elucidate the reconstitution of CD8+ T cells by separate analysis of putative naïve CD95− CD28+, memory CD95+ CD28+ and CD28− T cell compartments after acute maximal depletion by high‐dose chemotherapy (HD‐ChT) in women with high‐risk breast cancer. We found that recovery of putative naïve CD8+ CD95− CD28+ and CD4+ CD95− CD28+ T cells, was compatible with a thymus‐dependent regenerative pathway since their recovery was slow and time‐dependent, their values were tightly related to each other, and their reconstitution patterns were inversely related to age. By analysing non‐naïve T cells, a striking diversion between putative memory T cells and CD28− T cells was found. These latter increased early well beyond normal values, thus playing a pivotal role in total T‐cell homeostasis, and contributed to reduce the CD4 : CD8 ratio. In contrast, putative memory T cells returned to values not significantly different from those seen in patients at diagnosis, indicating that this compartment may recover after HD‐ChT. At 3–5 years after treatment, naïve T cells persisted at low levels, with expansion of CD28− T cells, suggesting that such alterations may extend further. These findings indicate that CD28− T cells were responsible for ‘blind’ T‐cell homeostasis, but support the notion that memory and naïve T cells are regulated separately. Given their distinct dynamics, quantitative evaluation of T‐cell pools in patients undergoing chemotherapy should take into account separate analysis of naïve, memory and CD28− T cells.