Rapid Helper T-Cell Recovery at 3 Months Correlates to Successful Transplant Outcomes after Allogeneic Stem Cell Transplantation.

Background: The current study attempted to evaluate the role of a simple quantitative measurement of peripheral lymphocyte subsets, especially CD4⁺ helper T-cell recovery, in predicting transplant outcomes, including overall survival (OS), non-relapse mortality (NRM), and opportunistic infections, after allogeneic stem cell transplantation (SCT).

Methods: A total of 69 patients receiving an allogeneic SCT were included. The disease entities were as follows: AML 42, ALL 5, CML 15, NHL 5, and high-risk MDS 2. The peripheral lymphocyte subset counts, such as CD3⁺ T-cells, CD3⁺4⁺ helper T-cells, CD3⁺8⁺ cytotoxic T-cells, CD19⁺ B-cells, and CD56⁺ natural killer (NK) cells, were measured 3, 6, and 12 months post-transplant.

Results: The CD19⁺ B-cell reconstitution was slow, while a rapid CD56⁺ NK cell recovery was noted. The CD4⁺ helper T-cell reconstitution at 3 months was strongly correlated with OS (p<0.0001), NRM (p=0.0007), and opportunistic infections (p=0.0108) when stratifying patients with cut-off value of 200×10⁶/L CD4⁺ helper T-cells. A rapid CD4⁺ helper T-cell recovery was also independently associated with a higher CD4⁺ helper T-cell transplant dose (p=0.006) and donor type (p<0.001) in a regression analysis. An early CD4⁺ helper T-cell recovery at 3 months was associated with a subsequent faster helper T-cell recovery until 12 months, yet not with B-cell recovery. In a multivariate survival analysis, a combination of a higher CD34⁺ cell dose and rapid recovery of CD4⁺ helper T-cells at 3 months was found to a have favorable prognosis in terms of OS (p=0.001, hazard ratio [HR] 3.653) and NRM (p=0.005, HR 4.836), yet not relapse.

Conclusion: A rapid recovery of the CD4⁺ helper T-cell count above 200×10⁶/L at 3 months seemed to correlate with a faster immune reconstitution and predict a successful transplant outcome.

Figure.

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The overall survival according to the helper T-cell counts at 3 months (A) and the difference of total T-(B) and helper T-cell (C) immune reconstitution within 1-year post-transplant according to helper T-cell counts at 3 months

Figure.

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The overall survival according to the helper T-cell counts at 3 months (A) and the difference of total T-(B) and helper T-cell (C) immune reconstitution within 1-year post-transplant according to helper T-cell counts at 3 months

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