Lymphocyte subset recovery and outcome after T-cell replete allogeneic hematopoietic SCT

L Bühlmann, AS Buser, N Cantoni, S Gerull… - Bone marrow …, 2011 - nature.com
L Bühlmann, AS Buser, N Cantoni, S Gerull, A Tichelli, A Gratwohl, M Stern
Bone marrow transplantation, 2011nature.com
Rapid recovery of lymphocytes after T-cell depleted hematopoietic SCT (HSCT) protects
from relapse of myeloid malignancies. Whether lymphocyte reconstitution has a similar role
after non-manipulated transplantation is controversial. We assessed numbers of CD4 and
CD8 T-cells, natural killer (NK) cells and B-cells, before and 1, 3, 6, 12 and 24 months after T-
cell replete transplantation in 345 patients. Lymphocyte subset counts up to 6 months post
transplant had no effect on relapse. Elevated number of NK cells 12 months post transplant …
Abstract
Rapid recovery of lymphocytes after T-cell depleted hematopoietic SCT (HSCT) protects from relapse of myeloid malignancies. Whether lymphocyte reconstitution has a similar role after non-manipulated transplantation is controversial. We assessed numbers of CD4 and CD8 T-cells, natural killer (NK) cells and B-cells, before and 1, 3, 6, 12 and 24 months after T-cell replete transplantation in 345 patients. Lymphocyte subset counts up to 6 months post transplant had no effect on relapse. Elevated number of NK cells 12 months post transplant protected from relapse. As a novel finding, early recovery of NK cells was associated with significant protection from TRM already at the 3 and 6 months time points (P= 0.03, P= 0.02). In Cox multivariable models, patients with NK cells above 150/μL were significantly protected from TRM (hazard ratio (HR) 0.45, 95% confidence interval (95% CI) 0.21–0.95, P= 0.03), an effect comparable in magnitude with that of carrying> 200 CD4 T-cells/μL (HR 0.37, 95% CI 0.19–0.74, P= 0.005). CD8 T-cell and B-cell recovery did not affect the rates of relapse or TRM. Early reconstitution of NK cells and CD4 T-cells in patients undergoing T-cell replete HSCT independently protected from TRM. Only a weak protection from disease relapse was noted for patients with high numbers of NK cells, and this occurred only late after transplantation.
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