Among adult patients with hematologic cancer who undergo allogeneic hematopoietic cell transplantation (allo-HCT), delayed immune recovery is linked with inferior overall survival (OS), according to research presented at the 2023 Tandem Transplantation and Cellular Therapy Meetings of ASTCT and CIBMTR. This link was not noted, however, in pediatric patients.

For this study, researchers evaluated whether patients who undergo allo-HCT who have a rapid and robust immune recovery have improved clinical outcomes, including OS rates.

Data from 2089 patients treated at 105 centers were included. The median patient age was 51 years, 57% of patients were male sex, 47% of patients had acute myeloid leukemia, and the graft type was peripheral blood in 58% of cases.

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The researchers categorized the patients into 4 groups by graft vs host disease (GVHD) prophylaxis therapy: CD34-positive selected T cell depleted peripheral blood stem cell grafts (TCD/CD34; 207 patients), post-transplant cyclophosphamide (PTCY; 304 patients), calcineurin inhibitors (CNI; 1203 patients), and CNI plus anti-thymocyte globulin (ATG; 375 patients).

At a prespecified interval at day 180, analysis showed that none of the 4 categorizations were predictive of immunoglobulin A levels or infection.

The day 100 landmark model showed, furthermore, that CD4 recovery was predicted by graft source (odds ratio [OR], 1.66 for peripheral blood vs bone marrow; P =.003) and GVHD prophylaxis, with ORs being below 0.4 for all modalities (TCD/CD34, CNI+ATG, and PTCY; all P <.001) compared with CNI only.

Further analysis showed that CD4 recovery was linked with OS among adult patients but not pediatric patients. Furthermore, the day 100 model showed that CD4 recovery predicted progression-free survival, but not relapse, infection rates, or chronic GVHD rates among adults.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 


Perales MA, Chemaly RF, Dandoy CE, et al. Delayed CD4+ T cell recovery after allogeneic hematopoietic cell transplantation is associated with decreased overall survival in adult but not pediatric recipients. Presented at: 2023 Tandem Transplantation and Cellular Therapy Meetings of ASTCT and CIBMTR; February 15-19, 2023. Abstract 409.