Impaired thymopoiesis predicts for a high risk of severe infections after reduced intensity conditioning without anti-thymocyte globulin in double umbilical cord blood transplantation.
Lucia E DuinhouwerNick BeijeBronno van der HoltAnita Rijken-SchelenCor H J LamersJudith SomersEric BraakmanJan J CornelissenPublished in: Bone marrow transplantation (2018)
Umbilical cord blood stem cell transplantation (UCBT) is associated with retarded hematopoietic recovery and immune reconstitution and a high infection-related morbidity and mortality, especially after conditioning including anti-thymocyte globulin (ATG). However, data on immune recovery, incidence of infections, and outcome in double UCBT (dUCBT) recipients receiving an ATG-free reduced intensity conditioning (RIC) are lacking. In this study, recovery of lymphocyte subsets, thymopoiesis, and its association with severe infections and clinical outcome was assessed in a group of 55 recipients of a dUCBT ATG-free RIC regimen. T cell recovery was severely protracted in the majority of patients. However, T cell receptor excision circle TREC+ T cells were detectable in 62% of patients at 3 months post-transplantation. A total of 128 common toxicity criteria grade 3-4 infections were observed in the first year post-transplantation. Non-relapse mortality at 12 months post-transplant was 16%, of which 78% infectious mortality. One-year overall survival was 73%. Patients who failed to recover thymopoiesis at 3 months post-transplantation were at a 3.3-fold higher risk of subsequent severe grade 3-4 infections.
Keyphrases
- umbilical cord
- mesenchymal stem cells
- stem cell transplantation
- end stage renal disease
- cell therapy
- risk factors
- high dose
- cardiovascular events
- bone marrow
- ejection fraction
- chronic kidney disease
- type diabetes
- newly diagnosed
- high intensity
- electronic health record
- drug induced
- cardiovascular disease
- peritoneal dialysis
- stem cells
- coronary artery disease
- oxidative stress
- artificial intelligence
- binding protein