CD4(+) T-cell reconstitution predicts survival outcomes after acute graft-versus-host-disease: a dual-center validation

Autor: Andromachi Scaradavou, Maria Cancio, Celina L. Szanto, Mirjam E. Belderbos, Elizabeth Klein, Wouter J.W. Kollen, Farid Boulad, Nancy A. Kernan, Dorine Bresters, Marc Bierings, Stefan Nierkens, Kevin J. Curran, Barbara Spitzer, Coco de Koning, Jurgen Langenhorst, Jaap Jan Boelens, Birgitta Versluijs, Caroline A. Lindemans, Susan E. Prockop, Alwin D. R. Huitema, Ichelle van Roessel, Richard J. O'Reilly
Jazyk: angličtina
Rok vydání: 2021
Předmět:
CD4-Positive T-Lymphocytes
Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Immunology
Graft vs Host Disease
Hematopoietic stem cell transplantation
Kaplan-Meier Estimate
Biochemistry
Gastroenterology
Severity of Illness Index
Young Adult
Immune Reconstitution
immune system diseases
Internal medicine
hemic and lymphatic diseases
Acute graft versus host disease
Medicine
Humans
In patient
Child
Proportional Hazards Models
Retrospective Studies
Transplantation
Cd4 t cell
business.industry
Proportional hazards model
Hematopoietic Stem Cell Transplantation
Cancer
Infant
Cell Biology
Hematology
medicine.disease
Allografts
CD4 Lymphocyte Count
Graft-versus-host disease
surgical procedures
operative
Treatment Outcome
Child
Preschool
Acute Disease
Female
business
Follow-Up Studies
Zdroj: Blood
Popis: Acute graft-versus-host-Disease (aGVHD) is a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). We previously showed that early CD4+ T-cell immune reconstitution (IR; CD4+ IR) predicts survival after HCT. Here, we studied the relation between CD4+ IR and survival in patients developing aGVHD. Pediatric patients undergoing first allogeneic HCT at University Medical Center Utrecht (UMC)/Princess Máxima Center (PMC) or Memorial Sloan Kettering Cancer Center (MSK) were included. Primary outcomes were nonrelapse mortality (NRM) and overall survival (OS), stratified for aGVHD and CD4+ IR, defined as ≥50 CD4+ T cells per μL within 100 days after HCT or before aGVHD onset. Multivariate and time-to-event Cox proportional hazards models were applied, and 591 patients (UMC/PMC, n = 276; MSK, n = 315) were included. NRM in patients with grade 3 to 4 aGVHD with or without CD4+ IR within 100 days after HCT was 30% vs 80% (P = .02) at UMC/PMC and 5% vs 67% (P = .02) at MSK. This was associated with lower OS without CD4+ IR (UMC/PMC, 61% vs 20%; P = .04; MSK, 75% vs 33%; P = .12). Inadequate CD4+ IR before aGVHD onset was associated with significantly higher NRM (74% vs 12%; P < .001) and inferior OS (24% vs 78%; P < .001). In this retrospective analysis, we demonstrate that early CD4+ IR, a simple and robust marker predictive of outcomes after HCT, is associated with survival after moderate to severe aGVHD. This association must be confirmed prospectively but suggests strategies to improve T-cell recovery after HCT may influence survival in patients developing aGVHD.
Databáze: OpenAIRE
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