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

Korean Journal of Internal Medicine 2020년 35권 4호 p.957 ~ 969
박진 ( Park Jin ) - Soonchunhyang University Bucheon Hospital Department of Internal Medicine

임성희 ( Lim Sung-Hee ) - Soonchunhyang University Bucheon Hospital Department of Internal Medicine
김세형 ( Kim Se-Hyung ) - Soonchunhyang University Bucheon Hospital Department of Internal Medicine
윤지나 ( Yun Ji-Na ) - Soonchunhyang University Bucheon Hospital Department of Internal Medicine
김찬규 ( Kim Chan-Kyu ) - Soonchunhyang University Bucheon Hospital Department of Internal Medicine
이상철 ( Lee Sang-Cheol ) - Soonchunhyang University Cheonan Hospital Department of Internal Medicine
원종호 ( Won Jong-Ho ) - Soonchunhyang University Seoul Hospital Department of Internal Medicine
홍대식 ( Hong Dae-Sik ) - Soonchunhyang University Bucheon Hospital Department of Internal Medicine
박성규 ( Park Seong-Kyu ) - Soonchunhyang University Bucheon Hospital Department of Internal Medicine

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.

키워드

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