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REAL-LIFE DATA ON IMMUNE RECONSTITUTION AFTER ALLOGENIC STEM CELL TRANSPLANTATION: AN OBSERVATIONAL STUDY IN PEDIATRIC PATIENTS
  • +8
  • Aline Risson Belinovski,
  • Polliany Dorini Pelegrina,
  • Alberto Cardoso Martins Lima,
  • Gisele Loth,
  • Adriana Mello Rodrigues,
  • Cilmara Kuwahara,
  • Ana Luiza Rodrigues,
  • Fernanda Moreira de Lara Benini,
  • Fábio Araujo Motta,
  • Carolina Prando,
  • Carmem Bonfim
Aline Risson Belinovski
Hospital Pequeno Príncipe

Corresponding Author:[email protected]

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Polliany Dorini Pelegrina
Hospital Pequeno Príncipe
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Alberto Cardoso Martins Lima
Universidade Federal do Paraná Hospital de Clínicas, Federal University of Paraná
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Gisele Loth
Hospital Pequeno Príncipe
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Adriana Mello Rodrigues
Hospital Pequeno Príncipe
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Cilmara Kuwahara
Hospital Pequeno Principe
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Ana Luiza Rodrigues
Hospital Pequeno Principe
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Fernanda Moreira de Lara Benini
Hospital Pequeno Príncipe
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Fábio Araujo Motta
Hospital Pequeno Príncipe
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Carolina Prando
Hospital Pequeno Príncipe
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Carmem Bonfim
Hospital Pequeno Príncipe
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Abstract

Background: Immune reconstitution (IR) after allogenic hematopoietic stem cell transplantation (allo-HSCT) is a long and progressive process intrinsically correlated to therapeutic success. It is essential to understand interfering factors in IR to prevent HSCT-related mortality. Methods: We retrospectively evaluated absolute lymphocyte count (ALC) and lymphocyte subtypes of 111 pediatric patients with allogeneic HSCT for malignant and non-malignant diseases from 2013 to 2018. ALC recovery on day +30 (D+30), +100 (D+100) and +180 (D+180) and subtypes CD3+CD4+, CD3+CD8+, CD19+ and CD16+CD56+ on D+100 were correlated to the HSCT procedure, clinical outcomes, and survival. Results: ALC had a gradual increase on D+30, D+100 and D+180 (medians 634/μL, 1 022/μL and 1 541/μL, respectively). On D+100, CD3+CD8+ achieved the highest recovery rate (68%), followed by CD16+CD56+ (47%), CD3+CD4+ (39%) and CD19+ (8%). Adequate ALC recovery on D+30 was associated with age <8 years, bone marrow grafts, myeloablative conditioning, and non-haploidentical donors. The use of serotherapy correlated to a poor ALC recovery on D+180. Counts of ALC and CD3+CD8+ on D+100 were higher in patients with cytomegalovirus infection. CD3+CD4+ recovery was associated with age <8 years, non-malignant disease and a lower incidence of acute graft-versus-host disease ≥grade 2. Further, ALC and CD3+CD4+ recovery on D+100 resulted in higher overall survival, as ALC was determinant regardless of disease type (HR 3.65, 1.05-12.71, P=0.04). Conclusion: Several factors influenced IR after allo-HSCT. ALC≥500/μL on D+100 was found to be a simple IR biomarker and a good predictor of survival, easily available to resource-limited countries.