Delayed immune reconstitution after allogeneic transplantation increases the risks of mortality and chronic GVHD

Nelli Bejanyan, Claudio G Brunstein, Qing Cao, Aleksandr Lazaryan, Xianghua Luo, Julie M Curtsinger, Rohtesh S. Mehta, Erica D Warlick, Sarah A. Cooley, Bruce R Blazar, Jeffrey S Miller, Daniel Weisdorf, John E Wagner, Michael R. Verneris

Research output: Contribution to journalArticlepeer-review

67 Scopus citations


Slow immune reconstitution is a major obstacle to the successful use of allogeneic hematopoietic cell transplantation (allo-HCT). As matched sibling donor (MSD) allo-HCT is regarded as the gold standard, we evaluated the pace of immune reconstitution in 157 adult recipients of reduced-intensity conditioning followed by MSD peripheral blood HCT (n = 68) and compared these to recipients of umbilical cord blood (UCB; n = 89). At day 28, UCB recipients had fewer natural killer (NK) cells than MSD recipients, but thereafter, NK cell numbers (and their subsets) were higher in UCB recipients. During the first 6 months to 1 year after transplant, UCB recipients had slower T-cell subset recovery, with lower numbers of CD3+, CD8+, CD8+ naive, CD4+ naive, CD4+ effector memory T, regulatory T, and CD31CD561 T cells than MSD recipients. Notably, B-cell numbers were higher in UCB recipients from day 60 to 1 year. Bacterial and viral infections were more frequent in UCB recipients, yet donor type had no influence on treatment-related mortality or survival. Considering all patients at day 28, lower numbers of total CD4+ T cells and naive CD4+ T cells were significantly associated with increased infection risk, treatment-related mortality, and chronic graft-versus-host disease (GVHD). Patients with these characteristics may benefit from enhanced or prolonged infection surveillance and prophylaxis as well as immune reconstitution-accelerating strategies.

Original languageEnglish (US)
Pages (from-to)909-922
Number of pages14
JournalBlood Advances
Issue number8
StatePublished - Apr 24 2018

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© 2018 by The American Society of Hematology.


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