Korean J Intern Med.  2020 Jul;35(4):957-969. 10.3904/kjim.2018.414.

Is immunological recovery clinically relevant at 100 days after allogeneic transplantation?

Affiliations
  • 1Division of Hemato-oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
  • 2Division of Hemato-oncology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
  • 3Division of Hemato-oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea

Abstract

Background/Aims
Immune reconstitution following allogeneic hematopoietic stem cell transplantation (HSCT) is affected by multiple variables during the transplantation.
Methods
We assessed the clinical factors contributing to immune function reconstitution at 100 days post-allogeneic HSCT in 114 patients receiving fludarabine-based conditioning. Immunophenotypic analysis using flow cytometry was performed to evaluate the percentage and the absolute numbers of T-cell subsets, natural killer cells, and B-cells as clinical outcomes.
Results
Tacrolimus-based graft-versus-host disease (GVHD) prophylaxis, T-cell depletion, and acute GVHD were significantly associated with delayed immune reconstitution of T-cell subsets. The incidence of chronic GVHD was significantly increased in the normal recovery group compared to the abnormal group (p = 0.01). Epstein-Barr virus reactivation was more frequently observed in the abnormal group of T-cell subsets (p = 0.045). All viral reactivation events including cytomegalovirus reactivation appeared to be more frequent in the abnormal group of T-cell subsets.
Conclusions
The immune recovery status post-allogeneic HSCT was affected by GVHD prophylactic regimens, especially in cases receiving tacrolimus-based GVHD prophylaxis, T-cell depletion, and possibly those manifesting acute GVHD. Delayed immune reconstitution might increase the morbidity due to viral reactivation. Treatment strategies are needed to prevent infectious complications and enhance immune reconstitution based on the immune recovery status following allogeneic HSCT with fludarabine-based conditioning.

Keyword

Hematopoietic stem cell transplantation; Immunity; Treatment outcomes; Graft vs host disease
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