Early CD4+ T cell reconstitution as predictor of outcomes after allogeneic hematopoietic cell transplantation Journal Article
| Authors: | van Roessel, I.; Prockop, S.; Klein, E.; Boulad, F.; Scaradavou, A.; Spitzer, B.; Kung, A.; Curran, K.; O'Reilly, R. J.; Kernan, N. A.; Cancio, M.; Boelens, J. J. |
| Article Title: | Early CD4+ T cell reconstitution as predictor of outcomes after allogeneic hematopoietic cell transplantation |
| Abstract: | Background: An association between early CD4+ T cell immune reconstitution (CD4+ IR) and survival after T-replete allogeneic hematopoietic cell transplantation (HCT) has been previously reported. Here we report validation of this relationship in a separate cohort that included recipients of ex vivo T-cell-depleted (TCD) HCT. We studied the relationship between CD4+ IR and clinical outcomes. Methods: A retrospective analysis of children/young adults receiving their first allogeneic HCT for any indication between January 2008 and December 2017 was performed. We related early CD4+ IR (defined as achieving >50 CD4+ T cells/μL on two consecutive measures within 100 days of HCT) to overall survival (OS), relapse, non-relapse mortality (NRM), event-free survival (EFS) and acute graft-versus-host disease (aGVHD). Fine and Gray competing risk models and Cox proportional hazard models were used. Results: In this analysis, 315 patients with a median age of 10.4 years (interquartile range 5.0–16.5 years) were included. The cumulative incidence of CD4+ IR at 100 days was 66.7% in the entire cohort, 54.7% in TCD (N = 208, hazard ratio [HR] 0.47, P < 0.001), 90.0% in uCB (N = 40) and 89.6% in T-replete (N = 47) HCT recipients. In multi-variate analyses, not achieving early CD4+ IR was a predictor of inferior OS (HR 2.35, 95% confidence interval [CI] 1.46–3.79, P < 0.001) and EFS (HR 1.80, 95% CI 1.20–2.69, P = 0.004) and increased NRM (HR 6.58, 95% CI 2.82–15.38, P < 0.001). No impact of CD4+ IR on relapse or aGVHD was found. Within the TCD group, similar associations were observed. Conclusion: In this HCT cohort, including recipients of TCD HCT, we confirmed that early CD4+ IR was an excellent predictor of outcomes. Finding strategies to predict or improve CD4+ IR may influence outcomes. © 2020 International Society for Cell and Gene Therapy |
| Keywords: | pediatric; immune reconstitution; t-cell reconstitution; cd4 t cells; hematopoietic transplant |
| Journal Title: | Cytotherapy |
| Volume: | 22 |
| Issue: | 9 |
| ISSN: | 1465-3249 |
| Publisher: | Elsevier Science Ltd. |
| Date Published: | 2020-09-01 |
| Start Page: | 503 |
| End Page: | 510 |
| Language: | English |
| DOI: | 10.1016/j.jcyt.2020.05.005 |
| PUBMED: | 32622752 |
| PROVIDER: | scopus |
| PMCID: | PMC7484404 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 September 2020 -- Source: Scopus |
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