title: Low Counts of Plasmacytoid Dendritic Cells after Engraftment Are Associated with High Early Mortality after Allogeneic Stem Cell Transplantation.
abstract: Dendritic cells (DCs) are antigen-presenting cells that drive immune responses and tolerance and are divided in different subsets: myeloid DCs (mDCs: lineage-; HLA-DR+, 11c+), plasmacytoid dendritic cells (pDCs: HLA-DR+, CD123+), and monocyte-derived DCs (moDC: lineage-, 11c+, 16+). After hematopoietic stem cell transplantation (HSCT), low DC counts in the recipients' peripheral blood (PB) have been associated with worse outcomes, but the relevance of DC graft content remains unclear, and there are few data in the setting of unrelated donor HSCT. We evaluated the DC graft content and monitored DC recovery in PB from 111 HSCT recipients (median age, 17 years; range 1 to 74), who received bone marrow (46%), umbilical cord blood (32%), or PB (22%) from unrelated (81%) or related donors (19%). In 86 patients with sustained allogeneic recovery, patients with higher counts of all DC subsets (pDC, mDC, and moDC) 3 weeks after engraftment had lower incidence of nonrelapse mortality (NMR) and acute graft-versus-host disease (aGVHD) and better survival. pDC counts were associated with more striking results: patients with higher pDC counts had much lower incidences of NRM (3% versus 47%, P < .0001), lower incidence of aGVHD (24% versus 67%, P < .0001), and better overall survival (92% versus 45%, P < .0001). In contrast, higher pDC counts in the graft was associated with an increased risk of aGVHD (55% versus 26%, P = .02). Our results indicate that DC counts are closely correlated with HSCT outcomes and warrant further prospective evaluation and possible early therapeutic interventions to ameliorate severe aGVHD and decrease mortality.
authors: Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil. Electronic address: matheus.vescovi@gmail.com.
authors: Matheus Vescovi
authors: MV
authors: Gonçalves
authors: Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Mihoko
authors: M
authors: Yamamoto
authors: Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Eliza Yurico Sugano
authors: EY
authors: Kimura
authors: Fundação Dr Amaral Carvalho, Jau, Brazil.
authors: Vergílio Antônio Rensi
authors: VA
authors: Colturato
authors: Fundação Dr Amaral Carvalho, Jau, Brazil.
authors: Mair Pedro
authors: MP
authors: de Souza
authors: Fundação Dr Amaral Carvalho, Jau, Brazil.
authors: Marcos
authors: M
authors: Mauad
authors: Fundação Dr Amaral Carvalho, Jau, Brazil.
authors: Maura Valerio
authors: MV
authors: Ikoma
authors: Centro de Oncologia, Hospital Sírio Libanês, São Paulo, Brazil.
authors: Yana
authors: Y
authors: Novis
authors: Eurocord/Saint-Louis Hospital, Paris, France; Churchill Hospital, Oxford University Hospital, Oxford, United Kingdom.
authors: Vanderson
authors: V
authors: Rocha
authors: Instituto de Oncologia Pediátrica, São Paulo, Brazil.
authors: Valeria Cortez
authors: VC
authors: Ginani
authors: Instituto de Oncologia Pediátrica, São Paulo, Brazil.
authors: Olga Margareth
authors: OM
authors: Wanderley de Oliveira Felix
authors: Hospital Samaritano, São Paulo, Brazil.
authors: Adriana
authors: A
authors: Seber
authors: Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Fabio Rodrigues
authors: FR
authors: Kerbauy
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Nelson
authors: N
authors: Hamerschlak
authors: Centro de Investigación del Cáncer (CIC,I BMCC USAL-CSIC); Servicio General de Citometría, Departamento de Medicina, IBSAL, Universidad de Salamanca, Salamanca, Spain.
authors: Alberto
authors: A
authors: Orfao
authors: Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo, São Paulo, Brazil; Centro de Oncologia, Hospital Sírio Libanês, São Paulo, Brazil.
authors: Celso Arrais
authors: CA
authors: Rodrigues
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002452:Cell Count; D019070:Cell Lineage / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D003713:Dendritic Cells / Q000145:classification / Q000276:immunology / Q000473:pathology*; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000401:mortality*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D035781:Siblings; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists
keywords: Dendritic cells; Graft-versus-host disease; Immune recovery; Nonrelapse mortality; Transplantation