title: High CD8+ lymphocyte dose in the autograft predicts early absolute lymphocyte count recovery after peripheral hematopoietic stem cell transplantation.
abstract: Early lymphocyte recovery (ELR) after autologous peripheral hematopoietic stem cell transplantation (ASCT) is an independent predictor for survival in patients with hematological and non-hematological cancers. Sixty-five ASCT for hematological cancers were retrospectively analyzed to identify the factors associated with ELR and to assess the impact of different mobilization regimens on the pre-collection absolute lymphocyte count (ALC). The CD8+ lymphocyte dose in the autograft and the pre-mobilization ALC were independently associated with ELR (P < 0.001 and P = 0.008, respectively). CD8+ lymphocyte doses higher than 0.1 x 10(9)/kg were strongly associated with ELR [P < 0.001, odds ratio 25.22, 95% confidence interval (CI) 4.98-127.69] and this cutoff may be used to predict ELR (P = 0.001, area under the curve 0.75, 95% CI 0.62-0.88). Mobilization with granulocyte colony-stimulating factor (G-CSF) alone, the pre-collection ALC and the number of apheresis sessions were independently associated with the CD8+ lymphocyte dose (P = 0.04, P = 0.001, and P < 0.001, respectively). The number of aphereses was the variable with the strongest correlation to the CD8+ lymphocyte dose (r(s) = 0.68, P < 0.001). Median pre-mobilization ALC was higher than pre-collection ALC in the subgroup of patients without ELR mobilized with chemotherapy followed by G-CSF (1090 vs. 758 lymphocytes/microL; P < 0.001). This reduction was not significant in the subgroup with ELR mobilized with chemotherapy plus G-CSF (1920 vs. 1539/microL, respectively; P = 0.23). These results suggest that the CD8+ lymphocyte dose in the autograft is critical for ELR after ASCT and also demonstrates that mobilization with chemotherapy followed by G-CSF significantly decreases the pre-collection ALC, especially in patients with low pre-mobilization ALC.
authors.affiliation: Hematopoietic Stem Cell Transplantation Program, Hemorio, Rio de Janeiro, RJ, Brazil. elias.atta@hemorio.rj.gov.br
authors.forename: Elias Hallack
authors.initials: EH
authors.lastname: Atta
authors.forename: Alexandre Mello
authors.initials: AM
authors.lastname: de Azevedo
authors.forename: Angelo
authors.initials: A
authors.lastname: Maiolino
authors.forename: Cláudia Júlia Bruzzi Porto
authors.initials: CJ
authors.lastname: Coelho
authors.forename: Silvia Maria Patiño
authors.initials: SM
authors.lastname: Sarcinelli
authors.forename: Cláudia
authors.initials: C
authors.lastname: de Alvarenga Máximo
authors.forename: Vera Lúcia Neves
authors.initials: VL
authors.lastname: Marra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018414:CD8-Positive T-Lymphocytes / Q000637:transplantation*; D002648:Child; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects*; D019337:Hematologic Neoplasms / Q000628:therapy*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007937:Leukapheresis; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D016179:Granulocyte Colony-Stimulating Factor