title: The impact of early CD4+ lymphocyte recovery on the outcome of patients who undergo allogeneic bone marrow or peripheral blood stem cell transplantation.
abstract: BACKGROUND
  Different factors influence the clinical outcome of allogeneic transplants, the foremost being good immune recovery.
  
  
  METHODS
  The purpose of this study was to evaluate the influence of different factors, such as stem cell source, type of donor, conditioning regimen and acute graft-versus-host disease, on early lymphocyte recovery after transplantation. We then analyzed the impact of early CD4+ cell count on overall survival, transplant-related mortality and disease-related mortality.
  
  
  RESULTS
  Univariate analysis with Spearman's rho showed a significant correlation between early CD4+ cell recovery and overall survival, transplant-related mortality, stem cell source and type of donor. In multivariate analysis CD4+ cell count was significantly associated with (i) stem cell source, being higher in patients whose haematopoietic progenitor cells were obtained by apheresis than in those whose source of grafted cells was bone marrow, and (ii) type of donor, being higher in patients transplanted from sibling donors than in those whose graft was from an alternative donor. The ROC curve of CD4+ cell count indicated that a cut-off of 115 CD4+ cells/mL could differentiate groups with different outcomes. At 2 years follow-up, patients achieving this CD4+ cell count had significantly lower cumulative transplant-related mortality compared to patients who did not have this count (10%±4% versus 40%±8%, p=0.0026). At the 5-year follow-up, the overall survival rates were 77.5%±0.6% and 36%±7% (p=0.000) in patients with a CD4+ cell count ≥115/mL and in patients with CD4+ cell count ≤ 115/mL, respectively.
  
  
  CONCLUSIONS
  Early CD4+ cell recovery after allogeneic transplantation has a relevant impact on overall survival and transplant-related mortality and is influenced by two factors: stem cell source and type of donor.
authors.affiliation: Haematology and Bone Marrow Transplant Unit, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Fedele
authors.forename: Massimo
authors.initials: M
authors.lastname: Martino
authors.forename: Cristina
authors.initials: C
authors.lastname: Garreffa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Messina
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Console
authors.forename: Domenica
authors.initials: D
authors.lastname: Princi
authors.forename: Antonella
authors.initials: A
authors.lastname: Dattola
authors.forename: Tiziana
authors.initials: T
authors.lastname: Moscato
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Massara
authors.forename: Elisa
authors.initials: E
authors.lastname: Spiniello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Irrera
authors.forename: Pasquale
authors.initials: P
authors.lastname: Iacopino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000276:immunology* / Q000379:methods / Q000401:mortality; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods / Q000401:mortality; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000276:immunology / Q000379:methods / Q000401:mortality; D055815:Young Adult