Delayed T-cell recovery after hematopoietic cell transplantation is associated with decreased overall survival in adults
Abstract: Allogeneic hematopoietic cell transplantation (allo-HCT) can provide curative treatment for hematologic malignancies but is associated with prolonged lymphopenia that may contribute to an increased risk of infection and relapse, resulting in decreased survival. We hypothesized that patient...
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Elsevier
2025-07-01
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| Series: | Blood Advances |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2473952925002344 |
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| author | Miguel-Angel Perales Marcie Riches Naya He Michael J. Martens Roy F. Chemaly Christopher E. Dandoy Joshua A. Hill Miguel Angel Diaz Shahrukh Hashmi Susan Prockop Hillard M. Lazarus Amer M. Beitinjaneh Gerhard C. Hildebrandt Jeffery J. Auletta Paul Szabolcs |
| author_facet | Miguel-Angel Perales Marcie Riches Naya He Michael J. Martens Roy F. Chemaly Christopher E. Dandoy Joshua A. Hill Miguel Angel Diaz Shahrukh Hashmi Susan Prockop Hillard M. Lazarus Amer M. Beitinjaneh Gerhard C. Hildebrandt Jeffery J. Auletta Paul Szabolcs |
| author_sort | Miguel-Angel Perales |
| collection | DOAJ |
| description | Abstract: Allogeneic hematopoietic cell transplantation (allo-HCT) can provide curative treatment for hematologic malignancies but is associated with prolonged lymphopenia that may contribute to an increased risk of infection and relapse, resulting in decreased survival. We hypothesized that patients with rapid and robust CD4 T- and B-cell recovery have improved survival and decreased treatment-related mortality (TRM). A total of 2089 patients were included who underwent first allo-HCT for acute myeloid leukemia/acute lymphoblastic leukemia/myelodysplastic syndrome from 2008 to 2019 reported to the Center for International Blood and Marrow Transplant Research with available CD4 counts at days 100 and 180. Patients (median age, 51 years [range, 2-75]) were categorized into 4 groups based on graft-versus-host disease (GVHD) prophylaxis: ex vivo T-cell depletion (TCD/CD34), posttransplant cyclophosphamide, calcineurin inhibitor alone (CNI), or CNI with antithymocyte globulin. Based upon survival, we could identify optimal cutoff points for CD4+ T cells in pediatric (age of <20 years) patients: 248 × 106/L and 420 × 106/L at days 100 and 180, respectively; and in adult (age of >20 years) patients: 104 × 106/L and 115 × 106/L at days 100 and 180, respectively. In adults, day-100 CD4 count was associated with overall survival (OS), progression-free survival (PFS), and TRM but not relapse, incidence of infections, or chronic GVHD. Similarly, CD4 counts above the cutoff point at day 180 in adults were associated with improved OS, PFS, and TRM but no other outcomes. No clinical associations for CD4 counts were identifiable in pediatric patients. These findings underscore the importance of tailoring transplant strategies for adults to optimize immune recovery and improve patient outcomes. |
| format | Article |
| id | doaj-art-724c60b37c4d470aac6e7a06bcc95fad |
| institution | Matheson Library |
| issn | 2473-9529 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Blood Advances |
| spelling | doaj-art-724c60b37c4d470aac6e7a06bcc95fad2025-07-19T04:38:34ZengElsevierBlood Advances2473-95292025-07-0191435023517Delayed T-cell recovery after hematopoietic cell transplantation is associated with decreased overall survival in adultsMiguel-Angel Perales0Marcie Riches1Naya He2Michael J. Martens3Roy F. Chemaly4Christopher E. Dandoy5Joshua A. Hill6Miguel Angel Diaz7Shahrukh Hashmi8Susan Prockop9Hillard M. Lazarus10Amer M. Beitinjaneh11Gerhard C. Hildebrandt12Jeffery J. Auletta13Paul Szabolcs14Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY; Correspondence: Miguel-Angel Perales, Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 E 74th St, Box 59, New York, NY 10021;Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WICenter for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WICenter for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Division of Biostatistics, Data Science Institute, Medical College of Wisconsin, Milwaukee, WIDepartment of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TXDivision of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OHVaccine and Infectious Disease, Fred Hutchinson Cancer Center, Seattle, WA; Department of Medicine, University of Washington, Seattle, WADepartment of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, SpainDepartment of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN; College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab EmiratesDepartment of Hematopoietic Stem Cell Transplant, Dana-Farber Cancer Institute/Boston Children's Center for Cancer and Blood Disorders, Boston, MADepartment of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OHDivision of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FLDivision of Hematology and Medical Oncology, University of Missouri, Ellis Fischel Cancer Center, Columbia, MOCenter for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, MN; Division of Hematology/Oncology/Blood and Marrow Transplant and Division of Infectious Diseases, Nationwide Children’s Hospital, Columbus, OHDivision of Blood and Marrow Transplantation and Cellular Therapies, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA; Department of Pediatrics and Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PAAbstract: Allogeneic hematopoietic cell transplantation (allo-HCT) can provide curative treatment for hematologic malignancies but is associated with prolonged lymphopenia that may contribute to an increased risk of infection and relapse, resulting in decreased survival. We hypothesized that patients with rapid and robust CD4 T- and B-cell recovery have improved survival and decreased treatment-related mortality (TRM). A total of 2089 patients were included who underwent first allo-HCT for acute myeloid leukemia/acute lymphoblastic leukemia/myelodysplastic syndrome from 2008 to 2019 reported to the Center for International Blood and Marrow Transplant Research with available CD4 counts at days 100 and 180. Patients (median age, 51 years [range, 2-75]) were categorized into 4 groups based on graft-versus-host disease (GVHD) prophylaxis: ex vivo T-cell depletion (TCD/CD34), posttransplant cyclophosphamide, calcineurin inhibitor alone (CNI), or CNI with antithymocyte globulin. Based upon survival, we could identify optimal cutoff points for CD4+ T cells in pediatric (age of <20 years) patients: 248 × 106/L and 420 × 106/L at days 100 and 180, respectively; and in adult (age of >20 years) patients: 104 × 106/L and 115 × 106/L at days 100 and 180, respectively. In adults, day-100 CD4 count was associated with overall survival (OS), progression-free survival (PFS), and TRM but not relapse, incidence of infections, or chronic GVHD. Similarly, CD4 counts above the cutoff point at day 180 in adults were associated with improved OS, PFS, and TRM but no other outcomes. No clinical associations for CD4 counts were identifiable in pediatric patients. These findings underscore the importance of tailoring transplant strategies for adults to optimize immune recovery and improve patient outcomes.http://www.sciencedirect.com/science/article/pii/S2473952925002344 |
| spellingShingle | Miguel-Angel Perales Marcie Riches Naya He Michael J. Martens Roy F. Chemaly Christopher E. Dandoy Joshua A. Hill Miguel Angel Diaz Shahrukh Hashmi Susan Prockop Hillard M. Lazarus Amer M. Beitinjaneh Gerhard C. Hildebrandt Jeffery J. Auletta Paul Szabolcs Delayed T-cell recovery after hematopoietic cell transplantation is associated with decreased overall survival in adults Blood Advances |
| title | Delayed T-cell recovery after hematopoietic cell transplantation is associated with decreased overall survival in adults |
| title_full | Delayed T-cell recovery after hematopoietic cell transplantation is associated with decreased overall survival in adults |
| title_fullStr | Delayed T-cell recovery after hematopoietic cell transplantation is associated with decreased overall survival in adults |
| title_full_unstemmed | Delayed T-cell recovery after hematopoietic cell transplantation is associated with decreased overall survival in adults |
| title_short | Delayed T-cell recovery after hematopoietic cell transplantation is associated with decreased overall survival in adults |
| title_sort | delayed t cell recovery after hematopoietic cell transplantation is associated with decreased overall survival in adults |
| url | http://www.sciencedirect.com/science/article/pii/S2473952925002344 |
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