Early lymphocyte recovery predicts clinical outcome after HSCT with mycophenolate mofetil prophylaxis in the Japanese population

Abstract

Immune reconstitution affects clinical outcomes after allogeneic hematopoietic stem cell transplantation (HSCT), and it has been suggested that lymphocyte recovery affects survival after HSCT. However, few studies have examined lymphocyte recovery in Asian patients who received mycophenolate mofetil (MMF) prophylaxis for graft-versus-host disease. We retrospectively evaluated early lymphocyte recovery after HSCT among Japanese adults who received MMF prophylaxis. Patients were divided into two groups according to their median absolute lymphocyte count (ALC) on day 28 after HSCT as follows: the "low ALC group" (≤ 0.22 × 10 cells/L) and the "high ALC group" (> 0.22 × 10 cells/L). With a median follow-up of 317 days, the high ALC group showed significantly better overall survival than the low ALC group (at 1 year: 62 vs. 46%, P = 0.02). The high ALC group also tended to have better non-relapse mortality than the low ALC group (at 1 year: 13 vs. 23%, P = 0.08). There was no significant difference in relapse rate between the high and low ALC groups (at 1 year: 29 vs. 35%, P = 0.2). We conclude that among Japanese patients who received MMF prophylaxis, ALC on day 28 after HSCT was effective in predicting overall survival and non-relapse mortality.

Haematopoietic stem cell transplantation for hepatitis‐associated aplastic anaemia and non‐hepatitis‐associated aplastic anaemia: A propensity score‐matched analysis

“…Delayed or inadequate immune recovery profoundly impacts the incidence of infection, 33 recurrence of haematological disease 34 and OS 35,36 . We found that the patterns of immune reconstitution in the 1‐year post‐transplant period were broadly consistent between HAAA and AA patients.…”

The Composite Immune Risk Score predicts overall survival after allogeneic hematopoietic stem cell transplantation: A retrospective analysis of 1838 cases

“…To our knowledge, the present research is the largest cohort study of post-HSCT immune reconstitution to date. Similar to the intent of numerous studies in the past, [1][2][3][4][5][6][7][8][9][10]19,21,23,26 we aimed to delineate the relationship between immune reconstitution and clinical outcome.…”

“…To our knowledge, the present research is the largest cohort study of post‐HSCT immune reconstitution to date. Similar to the intent of numerous studies in the past, 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 19 , 21 , 23 , 26 we aimed to delineate the relationship between immune reconstitution and clinical outcome. Our study utilized unsupervised machine learning to identify the temporal patterns of multivariate immune variables after transplantation, which were then combined with survival modeling using grid‐search optimization to result in a Composite Immune Risk Score for predicting early mortality.…”

“…Previous studies usually did not conduct an independent validation of their major results and in addition were often limited by small population size (less than 200 patients) 1,3,6,[8][9][10][12][13][14][15][16][17][18][19][20][21][22][23][24] or short duration of immune profiling (1 year or less). 3,4,[6][7][8][9]11,12,14,15,17,19,[21][22][23]25 Moreover, aside from some exceptions, 10,26,27 researchers often did not evaluate multiple immune variables holistically when assessing a patient's immune reconstitution; in other words, there has been no consensus on how to assign a score to a patient's multi-time-point and multivariate immune data. 5 In this study, we focused on the "cell count recovery" aspect of immune reconstitution and retrospectively analyzed 1945 patients who received HSCT between 2012 and 2020 at two medical centers in China.…”

“…Due to the high heterogeneity of patients and overall small sample sizes, however, it is difficult to summarize all the published literature regarding post‐transplant immune reconstitution. Previous studies usually did not conduct an independent validation of their major results and in addition were often limited by small population size (less than 200 patients) 1 , 3 , 6 , 8 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 or short duration of immune profiling (1 year or less). 3 , 4 , 6 , 7 , 8 , 9 , 11 , 12 , 14 , 15 , 17 , 19 , 21 , 22 , 23 , 25 Moreover, aside from some exceptions, 10 , 26 , 27 researchers often did not evaluate multiple immune variables holistically when assessing a patient's immune reconstitution; in other words, there has been no consensus on how to assign a score to a patient's multi‐time‐point and multivariate immune data.…”