Yonsei Med J.  2013 Jan;54(1):62-70. 10.3349/ymj.2013.54.1.62.

Implication of Early Lymphocyte Recovery after Allogeneic Hematopoietic Stem Cell Transplantation in Children with Leukemia

• Han DK
• Baek HJ
• Kim SY
• Hwang TJ
• Kook H

• KMID: 1776919
• DOI: http://doi.org/10.3349/ymj.2013.54.1.62

Abstract

PURPOSE
The repopulating lymphocytes after allogeneic hematopoietic stem cell transplantation have an important role not only on the prevention of serious infections in the early transplantation period, but also on the killing of residual leukemic cells by graft-versus-leukemia effect. The aim of this study was to analyze the impact of lymphocyte recovery after allogeneic stem cell transplantation in children with hematologic malignancies.
MATERIALS AND METHODS
We evaluated 69 children transplanted for acute lymphoblastic leukemia (ALL) (n=34), acute myeloid leukemia (AML) (n=26), chronic leukemia (n=7) and juvenile myelomonocytic leukemia (n=2) between 1996 and 2008 at the Chonnam National University Hospital, Korea. The patients were grouped based on absolute lymphocyte counts (ALC) <500/microL or > or =500/microL at D+21 and D+30 after transplant.
RESULTS
Patients with a High ALC at D+21 and D+30 had a faster neutrophil and platelet engraftment. The High at D+30 group had a better 5 year overall survival (71% vs. 53%, p=0.043) and event-free survival (72% vs. 53%, p=0.065) than the Low at D+30 group. The incidence of grade II-IV acute and chronic graft-versus-host disease (GVHD), and relapse rate did not differ by the ALC counts. However, the Low at D+30 group had a significantly increased risk for transplant-related mortality (p=0.019). The univariate analysis showed that the factors associated with decreased survival were a Low ALC at D+30, patients with high risk ALL, and grade II-IV aGVHD in patients with ALL and AML.
CONCLUSION
Early posttransplant serial lymphocyte measurement would be a simple but useful method for predicting transplant outcomes.

Keyword

Absolute lymphocyte count; allogeneic stem cell transplantation; children; leukemia

MeSH Terms

Adolescent
Blood Platelets/metabolism
Child
Child, Preschool
Female
Graft vs Leukemia Effect
*Hematopoietic Stem Cell Transplantation
Humans
Infant
Killer Cells, Natural/cytology
Leukemia/*therapy
Lymphocyte Count
Lymphocytes/*cytology
Male
Neutrophils/cytology
Prognosis
Recurrence
Remission Induction
Republic of Korea
Retrospective Studies
Stem Cells/cytology
Transplantation Conditioning
Transplantation, Homologous
Treatment Outcome

Figure

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  Fig. 1 Overall survival (A) and event-free survival (B) of 69 consecutive children according to ALC at D+30 after HSCT. ALC, absolute lymphocyte counts; HSCT, hematopoietic stem cell transplantation; OS, overall survival; EFS, event-free survival.

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