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Pubmed ID :29678809
Publication Date : //

Delayed immune reconstitution after allogeneic transplantation increases the risks of mortality and chronic GVHD.


Slow immune reconstitution is a major obstacle to the successful use of allogeneic hematopoietic cell transplantation (allo-HCT). As matched sibling donor (MSD) allo-HCT is regarded as the gold standard, we evaluated the pace of immune reconstitution in 157 adult recipients of reduced-intensity conditioning followed by MSD peripheral blood HCT (n = 68) and compared these to recipients of umbilical cord blood (UCB; n = 89). At day 28, UCB recipients had fewer natural killer (NK) cells than MSD recipients, but thereafter, NK cell numbers (and their subsets) were higher in UCB recipients. During the first 6 months to 1 year after transplant, UCB recipients had slower T-cell subset recovery, with lower numbers of CD3, CD8, CD8 naive, CD4 naive, CD4 effector memory T, regulatory T, and CD3CD56 T cells than MSD recipients. Notably, B-cell numbers were higher in UCB recipients from day 60 to 1 year. Bacterial and viral infections were more frequent in UCB recipients, yet donor type had no influence on treatment-related mortality or survival. Considering all patients at day 28, lower numbers of total CD4 T cells and naive CD4 T cells were significantly associated with increased infection risk, treatment-related mortality, and chronic graft-versus-host disease (GVHD). Patients with these characteristics may benefit from enhanced or prolonged infection surveillance and prophylaxis as well as immune reconstitution-accelerating strategies.

Authors : Bejanyan Nelli , Brunstein Claudio G , Cao Qing , Lazaryan Aleksandr , Luo Xianghua , Curtsinger Julie , Mehta Rohtesh S , Warlick Erica , Cooley Sarah A , Blazar Bruce R , Miller Jeffrey S , Weisdorf Daniel , Wagner John E , Verneris Michael R ,

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