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The importance of graft cell composition in outcome after allogeneic stem cell transplantation in patients with malignant disease
Author(s) -
Svenberg Petter,
Wang Tengyu,
Uhlin Michael,
Watz Emma,
Remberger Mats,
Ringden Olle,
Mattsson Jonas,
Uzunel Mehmet
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13537
Subject(s) - medicine , hematopoietic stem cell transplantation , anti thymocyte globulin , gastroenterology , transplantation , cd8 , cd34 , graft versus host disease , cd19 , cohort , multivariate analysis , immunology , incidence (geometry) , stem cell , immune system , peripheral blood , physics , optics , biology , genetics
Abstract Background Graft‐versus‐host disease (GVHD) and relapse remain majobstacles ftreatment success in allogeneic hematopoietic stem cell transplantation (HSCT). In the present study, we evaluated the immune cell profile of the graft to outcome after HSCT. Study design and method Flow cytometry data of graft cell subsets [CD34 + , CD3 + , CD19 + , CD4 + , CD8 + , CD3‐CD56 + CD16 + , CD4 + CD127 low CD25 high ] from G‐CSF primed peripheral blood stem cell (PBSC) donors was collected retrospectively from 299 patients with hematological malignancies undergoing HSCT between 2006 and 2013. The association to overall survival, transplant‐related mortality (TRM), GVHD and probability of relapse was analyzed. Patients outcome from HLA‐identical sibling (Sib) (n = 97) and unrelated donors (URD) (n = 202) were analyzed separately as all URD patients received anti‐thymocyte globulin (ATG). Results Five‐year overall survival was similar in the two cohorts (68% (Sib) vs 65% (URD)). The relapse incidence was significantly lower in the Sib cohort (24% vs 35%, P = 0.04). Multivariate analysis in the URD group revealed an association between a higher CD8 + dose and less relapse (HR, 0.94; 95%CI, 0.90‐0.98; P = 0.006) as well as an association between higher CD34 + dose and both higher TRM (HR, 1.09; 95%CI, 1.02‐1.20; P = 0.02) and relapse (HR, 1.09; 95%CI, 1.01‐1.17; P = 0.025). The Sib analysis showed an association between a higher graft CD19 + dose and more severe acute GVHD (HR, 1,09; 95%CI, 1.03‐1.15; P = 0.003) and TRM (HR, 1.09; 95%CI, 1.01‐1.17; P = 0.036). In addition, a higher CD4 + graft content was associated to an increased risk for chronic GVHD (HR, 1.02; 95%CI 1.00‐1.04; P = 0.06). Conclusion These data indicate an importance of PBSC dongraft composition in patients with a hematological malignancy.