Low blood lymphocyte count at 30 days post transplant predicts worse acute GVHD and survival but not relapse in a large retrospective cohort

Abstract

Multiple reports have shown that low absolute lymphocyte count at day 30 (ALC30) after allogeneic hematopoietic SCT (AHSCT) is associated with higher risk of disease relapse and worse OS. However, these reports included heterogeneous populations with different grafts and GVHD prophylaxis. Therefore, we retrospectively evaluated the association of ALC30 with transplant outcomes in a cohort of 381 consecutive patients who underwent AHSCT between 2005 and 2010 and received T-replete PBSC grafts and Tacrolimus/Mycophenolate combination as GVHD prophylaxis. Median follow-up was 57 months. Lower ALC30 (⩽400 × 10 6 /L) was associated with lower OS and increased nonrelapse mortality (NRM) for the whole cohort as well as for recipients of SD and UD grafts separately. Lower ALC30 was associated with more severe acute GVHD (aGVHD; III-IV) for the entire cohort as well as for the SD and UD groups. No association was found between lower ALC30 and relapse. Pretransplant factors associated with lower ALC30 were: unrelated donors; HLA mismatch; older donors; lower recipient age; and lower CD34+ cell dose. In this large retrospective study, ALC30 ⩽ 400 × 10 6 /L was associated with worse OS, increased NRM and severe aGVHD.

Cord Blood Units with High CD3 + Cell Counts Predict Early Lymphocyte Recovery After In Vivo T Cell–Depleted Single Cord Blood Transplantation

“…In contrast to other studies, in our cohort the incidence of aGVHD was lower than that seen in recipients of double UCBT [36], a fact that could be explained by a lower infused cell dose and by the effect of ATG in our series. Moreover, the latter factor would explain why we did not observe an association between ALC and aGVHD, in disagreement with previous studies [37]. In myeloablative adult unrelated donor transplantation for hematologic malignancies, ATG has been associated with a lower incidence and severity of cGVHD and reduced late mortality risk.…”

“…In myeloablative adult unrelated donor transplantation for hematologic malignancies, ATG has been associated with a lower incidence and severity of cGVHD and reduced late mortality risk. Lindemans et al [37] reported the results of ATG inclusion in recipients of myeloablative or nonmyeloablative conditioning for malignant and nonmalignant diseases and found that although the probability of severe aGVHD was lower in the ATG-conditioned group, immune reconstitution was delayed and viral reactivation was greater in this group. Despite these results, that study and other studies [38,39] found similar survival in recipients of ATG-containing regimens and recipients of noneATGcontaining regimens.…”

Low incidence of severe cGvHD and late NRM in a phase II trial of thymoglobulin, tacrolimus and sirolimus for GvHD prevention

“…36 More robust early total lymphocyte reconstitution post transplant and specifically more innate immune cell reconstitution have been shown to correlate with less relapse and better post-transplant survival. 35,37,38…”

Antiviral Immune Monitoring and Support in Allogeneic Stem Cell Transplantation

“…After allogeneic hematopoietic stem cell transplant (HSCT), robust immune reconstitution is vital for establishment of immunity against viral and other microbial pathogens and for graft-versus-leukemia activity to prevent relapse of the hematopoietic malignancy [1]. Serial measurement and phenotypic analysis of blood immune cells to monitor reconstitution are often performed as standard of care, and kinetics of immune reconstitution have been associated with post-transplant outcomes in clinical studies [2][3][4]. Correlations between T cell immune reconstitution and antiviral immunity are important to understand and predict the risk of infection in the post-transplant setting.…”