Pre-transplantation thymic function is associated with the risk of acute graft versus host disease and cytomegalovirus viremia after allogeneic hematopoietic stem cell transplantation

Figures & data

Table 1. Patient characteristics.

	Total
No. patients	49
Recipient age in y, median (range)	35 (5–56)
Recipient sex ratio, no. female/no. male	27/22
Diagnosis, no.
AML	22
ALL	6
MDS	9
Aplastic anemia	8
Other	4
ABO, no.
Compatible	31
Incompatible	18
GVHD prophylaxis, no.
CSA and MTX	20
CSA and MTX and others	6
CSA	1
FK506 + MTX	17
FK506 + MTX and others	5
Conditioning regimen, no.
TBI-based	16
Chemo-based	33
Donor, no.
Matched sibling	29
Matched unrelated	9
HLA-haploidentical	11
Graft source, no.
PBSCs	45
Bone marrow	2
PBSCs + bone marrow	2
Median CD34 + cells infused, ×10^6/kg	2.4 (0.44–8.3)

Notes: AML: acute myeloid leukemia; ALL: acute lymphoblastic leukemia; MDS: myelodysplastic syndrome; CSA: cyclosporine A; MTX: methotrexate; FK506: tacrolimus; TBI: total body irradiation; PBSC: peripheral blood stem cell.

Figure 1. Kinetics of T-cell subsets and sjTREC after AHSCT. In each panel, results are expressed as absolute number of cells per μl periphery blood for T-cell subsets, copies per 10⁶ PBMCs and copies per ml periphery blood for sjTREC. Results of healthy donors are also included in each panel. Different panels show the distribution of a distinct cell subset at different time points: before AHSCT, and at 1 month, 2 months, 3 months. (A) CD3+T cells. (B) CD3+CD8+T cells. (C) CD3+CD4+T cells. (D) CD4+CD45RA+CD31+T cells. (E) sjTREC per ml blood. (F) sjTREC per 10⁶ PBMCs. (G) CD4+CD45RA+CD62L+T cells. Each box shows the median, quartiles, and extreme values.

Figure 2. sjTREC level was of predictive value for aGVHD in patients after AHSCT. Cumulative incidence of aGVHD in patients who underwent AHSCT (n = 40). Gray line indicates high sjTREC level, black dashed line indicates low sjTREC level. sjTREC levels are expressed in sjTREC per 10⁶ PBMCs (A) and sjTREC per ml blood (B).

Table 2. Cox multivariate analysis.

	P	HR (95%CI)
aGVHD
Age	P = 0.658	–
Matched sibling donor vs mismatched donor	P = 0.046	0.353 (0.128–0.984)
sjTREC (per 10^6 PBMCs)	P = 0.02	3.352 (1.214–9.258)
CMV viremia
Age	P = 0.830	–
Matched sibling donor vs mismatched donor	P = 0.001	0.072 (0.016–0.327)
sjTREC (per 10^6 PBMCs)	P = 0.002	9.949 (2.281–43.386)
CMV viremia
Age	P = 0.774	–
Matched sibling donor vs mismatched donor	P = 0.002	0.117 (0.030–0.453)
sjTREC (per ml blood)	P = 0.029	4.802 (1.173–19.667)

Notes: HR indicates hazard ratio; 95% CI, 95% confidence interval; – indicates not statistically significant; HR values are only provided where significant.

Figure 3. sjTREC level and CD31+RTE were of predictive value for CMV viremia in patients after AHSCT. Cumulative incidence of CMV viremia in patients who underwent AHSCT. Gray line indicates high sjTREC level, black dashed line indicates low sjTREC level. sjTREC are expressed in sjTREC copies per 10⁶ PBMCs (n = 40) (A) and sjTREC copies per ml blood (n = 40) (B) CD31+RTE are expressed in percentage in CD4+T cells (n = 32) (C) and μl blood (n = 31) (D).