Yanagi Masato, Kobayashi Ryoji, Matsushima Satoru, Hori Daiki, Kodama Koya, Suzuki Daisuke, Kobayashi Kunihiko
Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan.
Pediatr Int. 2022 Jan;64(1):e15222. doi: 10.1111/ped.15222.
Lymphocyte reconstitution after hematopoietic stem cell transplantation (HSCT) is important for the prevention of infections, as well as for the reduction of recurrence, by its graft versus tumor effect. However, these lymphocytes may also play a role in the development of graft-versus-host disease (GVHD). Few studies have investigated the association between lymphocyte reconstitution and clinical outcomes after HSCT.
This issue was investigated by retrospectively analyzing pediatric patients who received their first allogeneic-HSCT using a newly developed parameter, the LD-index, which evaluates both the intensity and duration of lymphopenia. A total of 101 patients underwent allo-HSCT from April 2007 to August 2019 in our hospital. Excluding patients who died before lymphocyte recovery or underwent multiple HSCT, 78 patients were analyzed for associations between the LD-index with various factors relating to HSCT.
A significantly high association was observed between a low LD-index and the incidence of chronic GVHD (P = 0.0019). Analysis of predictive factors for chronic GVHD was carried out using univariate analysis. Lower LD-index, donor source and duration of lymphopenia were found to be significant factors associated with chronic GVHD. Multivariate analysis, however, only identified an association between a lower LD-index and an increased incidence of chronic GVHD (P = 0.00081).
Early reconstitution of lymphocytes after allo-HSCT is associated with a higher incidence of chronic GVHD.
造血干细胞移植（HSCT）后的淋巴细胞重建对于预防感染以及通过其移植物抗肿瘤效应降低复发率很重要。然而，这些淋巴细胞也可能在移植物抗宿主病（GVHD）的发生中起作用。很少有研究调查HSCT后淋巴细胞重建与临床结局之间的关联。
通过回顾性分析使用新开发的参数LD指数（评估淋巴细胞减少的强度和持续时间）接受首次异基因HSCT的儿科患者来研究这个问题。2007年4月至2019年8月，我院共有101例患者接受了异基因HSCT。排除淋巴细胞恢复前死亡或接受多次HSCT的患者，对78例患者分析LD指数与HSCT相关的各种因素之间的关联。
观察到低LD指数与慢性GVHD的发生率之间存在显著的高度关联（P = 0.0019）。使用单因素分析对慢性GVHD的预测因素进行分析。发现较低的LD指数、供体来源和淋巴细胞减少的持续时间是与慢性GVHD相关的重要因素。然而，多因素分析仅确定较低的LD指数与慢性GVHD发生率增加之间存在关联（P = 0.00081）。
异基因HSCT后淋巴细胞的早期重建与慢性GVHD的较高发生率相关。
