Early recovery of T-cell function predicts improved survival after T-cell depleted allogeneic transplant

Abstract

Infection, relapse, and GVHD can complicate allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although the effect of poor immune recovery on infection risk is well-established, there are limited data on the effect of immune reconstitution on relapse and survival, especially following T-cell depletion (TCD). To characterize the pattern of immune reconstitution in the first year after transplant and its effects on survival and relapse, we performed a retrospective study in 375 recipients of a myeloablative TCD allo-HSCT for hematologic malignancies. We noted that different subsets recover sequentially, CD8 + T cells first, followed by total CD4 + and naïve CD4 + T cells, indicating thymic recovery during the first year after HSCT. In the multivariate model, a fully HLA-matched donor and recovery of T-cell function, assessed by PHA response at 6 months, were the only factors independently associated with OS and EFS. In conclusion, T-cell recovery is an important predictor of outcome after TCD allo-HSCT.

Keywords:

• Immune reconstitution
• allogeneic hematopoietic stem cell transplant
• T-cell depletion

Acknowledgements

We gratefully acknowledge the expert care provided to these patients by the fellows, house staff and nurses of Memorial Sloan Kettering Cancer Center.

Funding

This work was supported in part by National Institutes of Health [P01 CA23766] and NIH/NCI Cancer Center Support Grant [P30 CA008748]. Support was also received from NIH [U01HL069315] (JDG). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Support was also received from the Translational and Integrative Medicine Research Fund of Memorial Sloan-Kettering Cancer Center (JDG), Cycle for Survival (MAP), The New York Community Trust (MAP), and When Everyone Survives (MAP). This project has received funding from the European Union?s Seventh Programme for research, technological development and demonstration under grant agreement No [602587].

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at http://dx.doi.org/10.1080/10428194.2016.1265113.