Early and Long-Term Impaired T Lymphocyte Immune Reconstitution after Cord Blood Transplantation with Antithymocyte Globulin
Castillo, Nerea (Banc de Sang i Teixits)
Garcia Cadenas, Irene (Institut d'Investigació Biomèdica Sant Pau)
Barba, Pere (Hospital Universitari Vall d'Hebron)
Canals, Carme (Banc de Sang i Teixits)
Díaz de Heredia, Cristina (Hospital Universitari Vall d'Hebron)
Martino Bofarull, Rodrigo (Institut d'Investigació Biomèdica Sant Pau)
Ferrá, Christelle (Institut Català d'Oncologia)
Badell Serra, Isabel (Institut d'Investigació Biomèdica Sant Pau)
Elorza, Izaskun (Hospital Universitari Vall d'Hebron)
Malouf Sierra, Jorge 1971- (Institut d'Investigació Biomèdica Sant Pau)
Valcárcel, David (Hospital Universitari Vall d'Hebron)
Querol, Sergio (Banc de Sang i Teixits)
Universitat Autònoma de Barcelona

Date:	2017
Abstract:	Immune reconstitution is crucial to the success of allogeneic hematopoietic stem cell transplantation. Umbilical cord blood transplantation (UCBT) has been associated with delayed immune reconstitution. We characterized the kinetics and investigated the risk variables affecting recovery of the main lymphocyte subsets in 225 consecutive pediatric and adult patients (males, n = 126; median age, 15; range,. 3 to 60; interquartile range, 4 to 35) who underwent myeloablative single UCBT between 2005 and 2015 for malignant and nonmalignant disorders. Low CD4 and CD8 T cell counts were observed up to 12 months after UCBT. In contrast, B and natural killer cells recovered rapidly early after transplantation. In a multivariate regression model, factors favoring CD4 T cell recovery ≥ 200 cells/µL were lower dose antithymocyte globulin (ATG) (hazard ratio [HR], 3. 93; 95% confidence interval [CI], 2. 3 to 5. 83; P = . 001), negative recipient cytomegalovirus (CMV) serostatus (HR, 3. 76; 95% CI, 1. 9 to 5. 74; P = . 001), and younger age (HR, 2. 61; 95% CI, 1. 01 to 3. 47; P = . 03). Factors favoring CD8 T cell recovery ≥ 200 cells/µL were lower dose ATG (HR, 3. 03; 95% CI, 1. 4 to 5. 1; P = . 03) and negative recipient CMV serostatus (HR, 1. 9; 95% CI, 1. 63 to 2. 15; P = . 01). Our results demonstrate the significant negative impact of ATG on lymphocyte recovery. A reduction of the dose or omission of ATG could improve immune reconstitution and perhaps reduce opportunistic infections after UCBT.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Antithymocyte globulin ; Lymphocyte recovery ; Umbilical cord blood transplantation
Published in:	Biology of blood and marrow transplantation, Vol. 23 Núm. 3 (january 2017) , p. 491-497, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2016.11.014
PMID: 27888015

7 p, 732.4 KB

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