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Early lymphocyte reconstitution is associated with improved transplant outcome after cord blood transplantation
Authors:Sara K Tedeschi  Madan Jagasia  Brian G Engelhardt  Jennifer Domm  Adetola A Kassim  Wichai Chinratanalab  Susan Leigh Greenhut  Stacey Goodman  John P Greer  Friedrich Schuening  Haydar Frangoul  Bipin N Savani
Institution:1. Department of Mathematics, Elmhurst College, 190 Prospect Avenue, Elmhurst, IL 60126, USA;2. DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, 19 Jonkershoek Rd, Stellenbosch, 7600, South Africa;3. Laboratoire Interdisciplinaire des Environnements Continentaux, Universit de Lorraine, CNRS UMR 7360, 8 rue du General Delestraint, Metz 57070, France;4. Department of Biochemistry, Rush University Medical Center, 1735 W. Harrison St, Chicago, IL 60612, USA
Abstract:Background aimsPrevious studies have shown that rapid recovery of the absolute lymphocyte count (ALC) is associated with improved transplant outcomes after related and unrelated donor allogeneic stem cell transplantation (allo-SCT). No consistent association has been reported between lymphocyte recovery and transplant outcome after cord blood transplantation (CBT)MethodsWe reviewed the records of 40 consecutive CBT patients at our institution to determine the impact of lymphocyte recovery on transplant outcomeResultsThe majority of patients (83%) received CBT for hematologic malignancies. Patients with ALC ≥150/μL at 30 days post-CBT had decreased non-relapse mortality (NRM) (P = 0.011) and improved survival (P = 0.013) compared with ALC < 150/μL. Patients with ALC < 100/μL at 30 days post-CBT had a significantly higher rate of graft failure than those with ALC ≥100/μL (four of 10 versus one of 29; P = 0.011). ALC was positively correlated with the nucleated cell dose and inversely correlated with the patient's age. There was no relationship between disease risk, type of conditioning regimen, anti-thymocyte globulin and number of cord units on ALC recoveryConclusionsOur results indicate that ALC 30 days post-CBT is a surrogate for engraftment, and that low ALC (<150/μL) identifies an ‘at-risk’ population of patients after CBT. Studies are needed to determine ways to increase ALC cell numbers post-CBT, including ex vivo-expanded natural killer cells using adoptive immunotherapy, which might improve outcome after CBT.
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