Early Natural Killer Cell Reconstitution Predicts Overall Survival in T Cell-Replete Allogeneic Hematopoietic Stem Cell Transplantation.
Early immune reconstitution plays a critical role in clinical outcome after allogeneic hematopoietic stem cell transplantation (HSCT). Natural killer (NK) cells are the first lymphocytes to recover after transplantation and are considered powerful effector cells in HSCT. We aimed to evaluate the clinical impact of early NK cell recovery in T cell-replete transplant recipients. Immune reconstitution was studied in 298 adult patients undergoing HSCT for acute myeloid leukemia, acute lymphoblastic leukemia, and myelodysplastic syndrome from 2005 to 2013. In multivariate analysis NK cell numbers on day 30 (NK30) > 150 cells/µL were independently associated with superior overall survival (hazard ratio, .79; 95% confidence interval, .66 to .95; P = .01). Cumulative incidence analyses showed that patients with NK30 > 150 cells/µL had significantly less transplant-related mortality (TRM), P = .01. Patients with NK30 > 150 cells/µL experienced significantly lower numbers of life-threatening bacterial infections as well as viral infections, including cytomegalovirus. No association was observed in relation to relapse. These results suggest an independent protective effect of high early NK cell reconstitution on TRM that translates into improved overall survival after T cell-replete HSCT.
Department of Clinical Immunology, National University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: lia.minculescu@regionh.dk.
Lia
L
Minculescu
Department of Clinical Immunology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Hanne Vibeke
HV
Marquart
Hematopoietic Stem Cell Transplant Unit, Department of Hematology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Lone Smidstrup
LS
Friis
Hematopoietic Stem Cell Transplant Unit, Department of Hematology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Soeren Lykke
SL
Petersen
Hematopoietic Stem Cell Transplant Unit, Department of Hematology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Ida
I
Schiødt
Department of Clinical Immunology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Lars Peter
LP
Ryder
Hematopoietic Stem Cell Transplant Unit, Department of Hematology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Niels Smedegaard
NS
Andersen
Hematopoietic Stem Cell Transplant Unit, Department of Hematology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Henrik
H
Sengeloev
D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007239:Infections / Q000209:etiology; D007694:Killer Cells, Natural / Q000166:cytology*; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality / Q000628:therapy; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult
Allogeneic hematopoietic stem cell transplantation; HSCT; Immune reconstitution; Infections; Natural killer cells; T cell replete