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The importance of graft cell composition in outcome after allogeneic stem cell transplantation in patients with malignant disease
Karolinska Univ Hosp, Pediat Oncol Coagulat Sect, Solna, Sweden;Karolinska Inst, Dept Clin Res Ctr, Stockholm, Sweden.
Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.
Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.
Karolinska Univ Hosp, Dept Clin Immunol & Transfus Med, Stockholm, Sweden.
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2019 (English)In: Clinical Transplantation, ISSN 0902-0063, E-ISSN 1399-0012, Vol. 33, no 6, article id e13537Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019. Vol. 33, no 6, article id e13537
Keywords [en]
donor cell composition, flow cytometry, graft-vs-host disease, hematopoietic stem cell transplantation, peripheral blood stem cells, relapse
National Category
Hematology
Identifiers
URN: urn:nbn:se:uu:diva-390585DOI: 10.1111/ctr.13537ISI: 000473087200026PubMedID: 30873642OAI: oai:DiVA.org:uu-390585DiVA, id: diva2:1342429
Funder
Swedish Childhood Cancer Foundation, PR2015-0120Available from: 2019-08-13 Created: 2019-08-13 Last updated: 2019-08-13Bibliographically approved

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