title: Early and Long-Term Impaired T Lymphocyte Immune Reconstitution after Cord Blood Transplantation with Antithymocyte Globulin.
abstract: Immune reconstitution is crucial to the success of allogeneic hematopoietic stem cell transplantation. Umbilical cord blood transplantation (UCBT) has been associated with delayed immune reconstitution. We characterized the kinetics and investigated the risk variables affecting recovery of the main lymphocyte subsets in 225 consecutive pediatric and adult patients (males, n = 126; median age, 15; range, .3 to 60; interquartile range, 4 to 35) who underwent myeloablative single UCBT between 2005 and 2015 for malignant and nonmalignant disorders. Low CD4+and CD8+T cell counts were observed up to 12 months after UCBT. In contrast, B and natural killer cells recovered rapidly early after transplantation. In a multivariate regression model, factors favoring CD4+T cell recovery ≥ 200 cells/µL were lower dose antithymocyte globulin (ATG) (hazard ratio [HR], 3.93; 95% confidence interval [CI], 2.3 to 5.83; P = .001), negative recipient cytomegalovirus (CMV) serostatus (HR, 3.76; 95% CI, 1.9 to 5.74; P = .001), and younger age (HR, 2.61; 95% CI, 1.01 to 3.47; P = .03). Factors favoring CD8+T cell recovery ≥ 200 cells/µL were lower dose ATG (HR, 3.03; 95% CI, 1.4 to 5.1; P = .03) and negative recipient CMV serostatus (HR, 1.9; 95% CI, 1.63 to 2.15; P = .01). Our results demonstrate the significant negative impact of ATG on lymphocyte recovery. A reduction of the dose or omission of ATG could improve immune reconstitution and perhaps reduce opportunistic infections after UCBT.
authors.affiliation: Banc de Sang i Teixits, Barcelona, Spain. Electronic address: ncastillo@bst.cat.
authors.forename: Nerea
authors.initials: N
authors.lastname: Castillo
authors.affiliation: Adult Hematology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: García-Cadenas
authors.affiliation: Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Barba
authors.affiliation: Banc de Sang i Teixits, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Canals
authors.affiliation: Pediatric Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Díaz-Heredia
authors.affiliation: Adult Hematology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.affiliation: Adult Hematology Department, Institut Català d'Oncologia-Badalona, Barcelona, Spain.
authors.forename: Christelle
authors.initials: C
authors.lastname: Ferrà
authors.affiliation: Pediatric Hematology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Badell
authors.affiliation: Pediatric Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Izaskun
authors.initials: I
authors.lastname: Elorza
authors.affiliation: Adult Hematology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.affiliation: Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Valcárcel
authors.affiliation: Banc de Sang i Teixits, Barcelona, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Querol
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000009:adverse effects* / Q000627:therapeutic use; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology*; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000592:standards; D003587:Cytomegalovirus / Q000472:pathogenicity; D005260:Female; D006801:Humans; D000074243:Immune Reconstitution; D007223:Infant; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets / Q000166:cytology; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum
keywords: Antithymocyte globulin; Lymphocyte recovery; Umbilical cord blood transplantation