CMV exposure drives long-term CD57+ CD4 memory T cell inflation following allogeneic stem cell transplant.

Donor and recipient cytomegalovirus (CMV) serostatus correlate with transplant related mortality that is associated with reduced survival following allogeneic stem cell transplant (SCT). Prior epidemiologic studies have suggested that CMV seronegative recipients (R-) receiving a CMV seropositive graft (D+) experience inferior outcomes compared to other serostatus combinations, an observation that appears independent of viral reactivation. We therefore investigated the hypothesis that prior donor CMV exposure irreversibly modifies immunologic function after SCT. We identified a CD4+/CD57+/CD27- T cell subset that was differentially expressed between D+ and D- transplants and validated results with 120 patient samples. This T cell subset represents an average of 2.9% (D-/R-), 18% (D-/R+), 12% (D+/R-), and 19.6% (D+/R+) (p<0.0001) of the total CD4+ T cell compartment and stably persists for at least several years post-SCT. Even in the absence of CMV reactivation post-SCT, D+/R- transplants displayed a significant enrichment of these cells compared to D-/R- transplants (p=0.0078). These are effector memory cells (CCR7-/ CD45RA+/-) that express T-bet, EOMES, granzyme B, secrete Th1 cytokines, and are enriched in CMV-specific T cells. These cells are associated with decreased T cell receptor diversity (p<0.0001) and reduced proportions of major histocompatibility class II expressing classical monocytes (p<0.0001), myeloid (p=0.024), and plasmacytoid dendritic cells (p=0.0014). These data describe a highly expanded CD4+ T cell population and putative mechanisms by which prior donor or recipient CMV exposure may create a lasting immunologic imprint following SCT, providing a rationale for using D- grafts for R- transplant recipients.