title: Prognostic impact of immune status and hematopoietic recovery before and after fludarabine, IV busulfan, and antithymocyte globulins (FB2 regimen) reduced-intensity conditioning regimen (RIC) allogeneic stem cell transplantation (allo-SCT).
abstract: This retrospective analysis aimed to assess hematopoietic and immune recovery in a cohort of 53 patients [males: n = 33; median age: 59 yr (range: 22-70)] who received a FB2 (fludarabine 120-150 mg/m² + IV busulfan 6.4 mg/kg + antithymocyte globulin thymoglobulin 5 mg/kg) reduced-intensity conditioning (RIC) allo-stem cells transplantations (SCT). With a median follow-up of 19 months (range: 2-53), the 2-yr overall survival, disease-free survival (DFS), relapse incidence, and non-relapse mortality were 63%, 59.5%, 35%, and 6%, respectively. In univariate analysis, the factors correlated with a significantly higher 2-yr OS and DFS were a higher total circulating lymphocytes count at transplant (>730/mm(3) ; OS: 81% vs. 43%, P = 0.02; DFS: 73% vs. 45.5%, P = 0.03) and a higher recovery of leukocytes (>5300/mm(3) ) (2-yr OS: 81% vs. 44%, P = 0.007; 2-yr DFS: 72% vs. 46%, P = 0.08), neutrophils (>3200/mm(3) ) (2-yr OS: 76% vs. 50%, P = 0.03; 2-yr DFS: 67% vs. 52.0%, P = 0.1), and monocytes (>590/mm(3) ; 2-yr OS: 80% vs. 45%, P = 0.004; 2-yr DFS: 76% vs. 42%, P = 0.01) at day +30 post-transplant. In multivariate analysis, the only independent factors associated with a significantly higher OS and DFS were a better immune status at transplant (lymphocytes count >730/mm(3) ) and a higher monocytes count (>590/mm(3) ) at day +30 post-transplant. These results suggest that immune status and hematopoietic recovery before and after FB2 RIC allo-SCT can be significant predictors of outcome. This paves the way for future studies aiming to closely monitor the kinetics of immune recovery after RIC allo-SCT and to evaluate the impact of growth factors and other immunostimulatory cytokines in the setting of RIC allo-SCT.
authors.affiliation: Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique,  Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Le Bourgeois
authors.forename: Elsa
authors.initials: E
authors.lastname: Lestang
authors.forename: Thierry
authors.initials: T
authors.lastname: Guillaume
authors.forename: Jacques
authors.initials: J
authors.lastname: Delaunay
authors.forename: Sameh
authors.initials: S
authors.lastname: Ayari
authors.forename: Nicolas
authors.initials: N
authors.lastname: Blin
authors.forename: Aline
authors.initials: A
authors.lastname: Clavert
authors.forename: Benoit
authors.initials: B
authors.lastname: Tessoulin
authors.forename: Viviane
authors.initials: V
authors.lastname: Dubruille
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mahe
authors.forename: Virginie
authors.initials: V
authors.lastname: Roland
authors.forename: Thomas
authors.initials: T
authors.lastname: Gastinne
authors.forename: Steven
authors.initials: S
authors.lastname: Le Gouill
authors.forename: Philippe
authors.initials: P
authors.lastname: Moreau
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.forename: Lucie
authors.initials: L
authors.lastname: Planche
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000494:pharmacology / Q000627:therapeutic use*; D002066:Busulfan / Q000494:pharmacology / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007113:Immunity, Innate / Q000187:drug effects; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008223:Lymphoma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D019653:Myeloablative Agonists / Q000494:pharmacology / Q000627:therapeutic use*; D020127:Recovery of Function / Q000276:immunology; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000961:Antilymphocyte Serum; D019653:Myeloablative Agonists; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine