Immune Reconstitution after Hematopoietic Stem Cell Transplantation in Autoimmune Disease

Autologous hematopoietic stem cell transplantation (AHSCT) is a therapeutic procedure that has found specific indications in autoimmune disease. The conceptual mechanism of action is that ablation of the lymphoid system followed by immune reconstitution induces a “resetting” of immunological memory. Studies have revealed that the effects of immune reconstitution post-AHSCT include reduced numbers of proinflammatory cells and enhanced regulatory cells, suggesting a rebalancing of the disease-mediating and disease-protective components of disease. Amongst the relevant immune changes, extensive replacement of T cell clones has been demonstrated both in the peripheral blood and in the cerebrospinal fluid of patients with multiple sclerosis.