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

• Main Authors: Jin Park, Sung Hee Lim, Se Hyung Kim, Jina Yun, Chan Kyu Kim, Sang Cheol Lee, Jong Ho Won, Dae Sik Hong, Seong Kyu Park
• Format: Article
• Language: English
• Published: The Korean Association of Internal Medicine 2020-07-01
• Series: The Korean Journal of Internal Medicine
• Subjects: hematopoietic stem cell transplantation; immunity; treatment outcomes; graft vs host disease
• Online Access: http://www.kjim.org/upload/pdf/kjim-2018-414.pdf
• ISSN: 1226-3303; 2005-6648

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.