title: Impact of clinical factors and allograft leukocyte content on post-transplant lymphopenia, monocytopenia, and survival in patients undergoing allogeneic peripheral blood haematopoietic cell transplant.
abstract: BACKGROUND
  We have previously shown that lymphopenia and monocytopenia at 2-3 months post-allogeneic haematopoietic cell transplant (HCT) is associated with poor survival in recipients of both myeloablative and reduced intensity conditioning regimens. It is not known whether the graft leukocyte content has a role in early lymphocyte and monocyte recovery following allogeneic T-cell replete peripheral blood HCT.
  
  
  METHODS
  Haematologic recovery data, including absolute lymphocyte and monocyte counts (ALC and AMC, respectively) at day +15, +30, +60, and +100, and outcomes data were pooled from two prior independent cohorts, and parameters were correlated with leukocyte graft content in those individuals receiving peripheral blood progenitor cell grafts. 216 consecutive patients from 2001-2010 were included in the analysis.
  
  
  RESULTS
  Neither infused allograft lymphocyte, monocyte, granulocyte, nor CD34+ cell number per kilogram recipient body weight correlated with haematologic recovery parameters or overall survival in this cohort. Prognostic factors for overall survival based on multivariate analysis were as expected from the results of the previous independent cohorts and included severity of chronic GVHD (p < 0.001), development of post-transplant relapse (p = 0.001), day +60 AMC > 0.3 x 10(9) cells/L (p = 0.0015), and day +100 ALC > 0.3 x 10(9) cells/L (p < 0.001). Low monocyte and lymphocyte counts at the day +60 and day +100 time points were significantly associated with acute GVHD and/or CMV viraemia.
  
  
  CONCLUSIONS
  This study suggests that graft cell count does not influence post-transplant monocyte and lymphocyte recovery following T-cell replete allogeneic peripheral blood HCT. Post-transplant complications such as acute GVHD and/or CMV viraemia negatively influenced monocyte and lymphocyte recovery, and hence the survival. Further studies aimed at understanding the mechanisms behind sustained lymphopenia and monocytopenia post-transplant are needed.
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Thoma
authors.affiliation: Department of Pathology and Laboratory Medicine, Mayo Clinic Graduate School of Medicine, Rochester, MN USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Glejf
authors.affiliation: Department of Pathology and Laboratory Medicine, Mayo Clinic Graduate School of Medicine, Rochester, MN USA.
authors.forename: Eapen
authors.initials: E
authors.lastname: Jacob
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA.
authors.forename: Tanya J
authors.initials: TJ
authors.lastname: Huneke
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Phoenix, AZ USA.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: DeCook
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA.
authors.forename: Nicci D
authors.initials: ND
authors.lastname: Johnson
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA.
authors.forename: Mrinal M
authors.initials: MM
authors.lastname: Patnaik
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Hogan
authors.affiliation: Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA.
authors.forename: Laura F
authors.initials: LF
authors.lastname: Newell
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI USA.
authors.forename: Rekha
authors.initials: R
authors.lastname: Chandran
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Porrata
authors.affiliation: Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN USA ; Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health & Science University, Portland, OR USA ; Blood and Marrow Transplant Program, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455 USA.
authors.forename: Shernan G
authors.initials: SG
authors.lastname: Holtan
keywords: Allogeneic haematopoietic cell transplantation; CMV viraemia; GVHD; Lymphopenia; Monocytopenia