Impact of lymphocyte and monocyte recovery on the outcomes of allogeneic hematopoietic SCT with fludarabine and melphalan conditioning

L. J. Decook, M. Thoma, T. Huneke, N. D. Johnson, R. A. Wiegand, M. M. Patnaik, M. R. Litzow, W. J. Hogan, L. F. Porrata, S. G. Holtan

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

We have recently shown that lymphocyte and monocyte recovery by day +100 are associated with survival post myeloablative allogeneic hematopoietic transplant for acute leukemia. We hypothesized that lymphocyte and monocyte recovery would have a similar impact on survival in the reduced intensity setting. To test this hypothesis, we analyzed clinical data from 118 consecutive fludarabine/melphalan-conditioned patients by correlating peripheral blood absolute lymphocyte counts and monocyte counts (ALC and AMC, respectively) at days +15, +30, +60 and +100 with the outcomes. Multivariate analysis revealed that day +100 AMC (risk ratio (RR) 0.22, 95% confidence interval (CI) 0.07-0.73, P=0.01) and mild chronic GVHD (RR 0.09, 95% CI 0.005-0.43, P=0.008) were independently associated with survival. To explore whether the patterns of lymphocyte and monocyte recovery had a prognostic value, we performed unsupervised hierarchical clustering on the studied hematopoietic parameters and identified three patient clusters, A-C. Patient clusters A and B both had improved OS compared with cluster C (77.8 months vs not reached vs 22.3 months, respectively, P<0.001). No patient in cluster C had a day +100 AMC >300. Both severe acute GVHD and relapse occurred more frequently in cluster C. Our data suggest that patients with low AMC by day +100 post fludarabine/melphalan- conditioned allogeneic hematopoietic SCT may be at risk for poor outcomes.

Original languageEnglish (US)
Pages (from-to)708-714
Number of pages7
JournalBone Marrow Transplantation
Volume48
Issue number5
DOIs
StatePublished - May 1 2013

Keywords

  • GVHD
  • immune reconstitution
  • lymphocyte
  • monocyte
  • reduced intensity allogeneic hematopoietic SCT
  • relapse

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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