Impact of clinical factors and allograft leukocyte content on post-transplant lymphopenia, monocytopenia, and survival in patients undergoing allogeneic peripheral blood haematopoietic cell transplant

Mary D. Thoma, Jennifer Glejf, Eapen Jacob, Tanya J. Huneke, Lori J. DeCook, Nicci D. Johnson, Mrinal M. Patnaik, Mark R. Litzow, William J. Hogan, Laura Newell, Rekha Chandran, Luis F. Porrata, Shernan G. Holtan

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Abstract

Background: We have previously shown that lymphopenia and monocytopenia at 2–3 months post-allogeneic haematopoietic cell transplant (HCT) is associated with poor survival in recipients of both myeloablative and reduced intensity conditioning regimens. It is not known whether the graft leukocyte content has a role in early lymphocyte and monocyte recovery following allogeneic T-cell replete peripheral blood HCT. Methods: Haematologic recovery data, including absolute lymphocyte and monocyte counts (ALC and AMC, respectively) at day +15, +30, +60, and +100, and outcomes data were pooled from two prior independent cohorts, and parameters were correlated with leukocyte graft content in those individuals receiving peripheral blood progenitor cell grafts. 216 consecutive patients from 2001–2010 were included in the analysis. Results: Neither infused allograft lymphocyte, monocyte, granulocyte, nor CD34+ cell number per kilogram recipient body weight correlated with haematologic recovery parameters or overall survival in this cohort. Prognostic factors for overall survival based on multivariate analysis were as expected from the results of the previous independent cohorts and included severity of chronic GVHD (p < 0.001), development of post-transplant relapse (p = 0.001), day +60 AMC > 0.3 x 109 cells/L (p = 0.0015), and day +100 ALC > 0.3 x 109 cells/L (p < 0.001). Low monocyte and lymphocyte counts at the day +60 and day +100 time points were significantly associated with acute GVHD and/or CMV viraemia. Conclusions: This study suggests that graft cell count does not influence post-transplant monocyte and lymphocyte recovery following T-cell replete allogeneic peripheral blood HCT. Post-transplant complications such as acute GVHD and/or CMV viraemia negatively influenced monocyte and lymphocyte recovery, and hence the survival. Further studies aimed at understanding the mechanisms behind sustained lymphopenia and monocytopenia post-transplant are needed.

Original languageEnglish (US)
Article number14
JournalBMC Hematology
Volume14
Issue number1
DOIs
StatePublished - 2014

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Lymphopenia
Allografts
Blood Cells
Leukocytes
Transplants
Survival
Monocytes
Lymphocytes
Viremia
Lymphocyte Count
Cell Count
T-Lymphocytes
Granulocytes
Stem Cells
Multivariate Analysis
Body Weight

Keywords

  • Allogeneic haematopoietic cell transplantation
  • CMV viraemia
  • GVHD
  • Lymphopenia
  • Monocytopenia

ASJC Scopus subject areas

  • Molecular Biology
  • Hematology

Cite this

Impact of clinical factors and allograft leukocyte content on post-transplant lymphopenia, monocytopenia, and survival in patients undergoing allogeneic peripheral blood haematopoietic cell transplant. / Thoma, Mary D.; Glejf, Jennifer; Jacob, Eapen; Huneke, Tanya J.; DeCook, Lori J.; Johnson, Nicci D.; Patnaik, Mrinal M.; Litzow, Mark R.; Hogan, William J.; Newell, Laura; Chandran, Rekha; Porrata, Luis F.; Holtan, Shernan G.

In: BMC Hematology, Vol. 14, No. 1, 14, 2014.

Research output: Contribution to journalArticle

Thoma, Mary D. ; Glejf, Jennifer ; Jacob, Eapen ; Huneke, Tanya J. ; DeCook, Lori J. ; Johnson, Nicci D. ; Patnaik, Mrinal M. ; Litzow, Mark R. ; Hogan, William J. ; Newell, Laura ; Chandran, Rekha ; Porrata, Luis F. ; Holtan, Shernan G. / Impact of clinical factors and allograft leukocyte content on post-transplant lymphopenia, monocytopenia, and survival in patients undergoing allogeneic peripheral blood haematopoietic cell transplant. In: BMC Hematology. 2014 ; Vol. 14, No. 1.
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abstract = "Background: We have previously shown that lymphopenia and monocytopenia at 2–3 months post-allogeneic haematopoietic cell transplant (HCT) is associated with poor survival in recipients of both myeloablative and reduced intensity conditioning regimens. It is not known whether the graft leukocyte content has a role in early lymphocyte and monocyte recovery following allogeneic T-cell replete peripheral blood HCT. Methods: Haematologic recovery data, including absolute lymphocyte and monocyte counts (ALC and AMC, respectively) at day +15, +30, +60, and +100, and outcomes data were pooled from two prior independent cohorts, and parameters were correlated with leukocyte graft content in those individuals receiving peripheral blood progenitor cell grafts. 216 consecutive patients from 2001–2010 were included in the analysis. Results: Neither infused allograft lymphocyte, monocyte, granulocyte, nor CD34+ cell number per kilogram recipient body weight correlated with haematologic recovery parameters or overall survival in this cohort. Prognostic factors for overall survival based on multivariate analysis were as expected from the results of the previous independent cohorts and included severity of chronic GVHD (p < 0.001), development of post-transplant relapse (p = 0.001), day +60 AMC > 0.3 x 109 cells/L (p = 0.0015), and day +100 ALC > 0.3 x 109 cells/L (p < 0.001). Low monocyte and lymphocyte counts at the day +60 and day +100 time points were significantly associated with acute GVHD and/or CMV viraemia. Conclusions: This study suggests that graft cell count does not influence post-transplant monocyte and lymphocyte recovery following T-cell replete allogeneic peripheral blood HCT. Post-transplant complications such as acute GVHD and/or CMV viraemia negatively influenced monocyte and lymphocyte recovery, and hence the survival. Further studies aimed at understanding the mechanisms behind sustained lymphopenia and monocytopenia post-transplant are needed.",
keywords = "Allogeneic haematopoietic cell transplantation, CMV viraemia, GVHD, Lymphopenia, Monocytopenia",
author = "Thoma, {Mary D.} and Jennifer Glejf and Eapen Jacob and Huneke, {Tanya J.} and DeCook, {Lori J.} and Johnson, {Nicci D.} and Patnaik, {Mrinal M.} and Litzow, {Mark R.} and Hogan, {William J.} and Laura Newell and Rekha Chandran and Porrata, {Luis F.} and Holtan, {Shernan G.}",
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T1 - Impact of clinical factors and allograft leukocyte content on post-transplant lymphopenia, monocytopenia, and survival in patients undergoing allogeneic peripheral blood haematopoietic cell transplant

AU - Thoma, Mary D.

AU - Glejf, Jennifer

AU - Jacob, Eapen

AU - Huneke, Tanya J.

AU - DeCook, Lori J.

AU - Johnson, Nicci D.

AU - Patnaik, Mrinal M.

AU - Litzow, Mark R.

AU - Hogan, William J.

AU - Newell, Laura

AU - Chandran, Rekha

AU - Porrata, Luis F.

AU - Holtan, Shernan G.

PY - 2014

Y1 - 2014

N2 - Background: We have previously shown that lymphopenia and monocytopenia at 2–3 months post-allogeneic haematopoietic cell transplant (HCT) is associated with poor survival in recipients of both myeloablative and reduced intensity conditioning regimens. It is not known whether the graft leukocyte content has a role in early lymphocyte and monocyte recovery following allogeneic T-cell replete peripheral blood HCT. Methods: Haematologic recovery data, including absolute lymphocyte and monocyte counts (ALC and AMC, respectively) at day +15, +30, +60, and +100, and outcomes data were pooled from two prior independent cohorts, and parameters were correlated with leukocyte graft content in those individuals receiving peripheral blood progenitor cell grafts. 216 consecutive patients from 2001–2010 were included in the analysis. Results: Neither infused allograft lymphocyte, monocyte, granulocyte, nor CD34+ cell number per kilogram recipient body weight correlated with haematologic recovery parameters or overall survival in this cohort. Prognostic factors for overall survival based on multivariate analysis were as expected from the results of the previous independent cohorts and included severity of chronic GVHD (p < 0.001), development of post-transplant relapse (p = 0.001), day +60 AMC > 0.3 x 109 cells/L (p = 0.0015), and day +100 ALC > 0.3 x 109 cells/L (p < 0.001). Low monocyte and lymphocyte counts at the day +60 and day +100 time points were significantly associated with acute GVHD and/or CMV viraemia. Conclusions: This study suggests that graft cell count does not influence post-transplant monocyte and lymphocyte recovery following T-cell replete allogeneic peripheral blood HCT. Post-transplant complications such as acute GVHD and/or CMV viraemia negatively influenced monocyte and lymphocyte recovery, and hence the survival. Further studies aimed at understanding the mechanisms behind sustained lymphopenia and monocytopenia post-transplant are needed.

AB - Background: We have previously shown that lymphopenia and monocytopenia at 2–3 months post-allogeneic haematopoietic cell transplant (HCT) is associated with poor survival in recipients of both myeloablative and reduced intensity conditioning regimens. It is not known whether the graft leukocyte content has a role in early lymphocyte and monocyte recovery following allogeneic T-cell replete peripheral blood HCT. Methods: Haematologic recovery data, including absolute lymphocyte and monocyte counts (ALC and AMC, respectively) at day +15, +30, +60, and +100, and outcomes data were pooled from two prior independent cohorts, and parameters were correlated with leukocyte graft content in those individuals receiving peripheral blood progenitor cell grafts. 216 consecutive patients from 2001–2010 were included in the analysis. Results: Neither infused allograft lymphocyte, monocyte, granulocyte, nor CD34+ cell number per kilogram recipient body weight correlated with haematologic recovery parameters or overall survival in this cohort. Prognostic factors for overall survival based on multivariate analysis were as expected from the results of the previous independent cohorts and included severity of chronic GVHD (p < 0.001), development of post-transplant relapse (p = 0.001), day +60 AMC > 0.3 x 109 cells/L (p = 0.0015), and day +100 ALC > 0.3 x 109 cells/L (p < 0.001). Low monocyte and lymphocyte counts at the day +60 and day +100 time points were significantly associated with acute GVHD and/or CMV viraemia. Conclusions: This study suggests that graft cell count does not influence post-transplant monocyte and lymphocyte recovery following T-cell replete allogeneic peripheral blood HCT. Post-transplant complications such as acute GVHD and/or CMV viraemia negatively influenced monocyte and lymphocyte recovery, and hence the survival. Further studies aimed at understanding the mechanisms behind sustained lymphopenia and monocytopenia post-transplant are needed.

KW - Allogeneic haematopoietic cell transplantation

KW - CMV viraemia

KW - GVHD

KW - Lymphopenia

KW - Monocytopenia

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