loading page

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

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.