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Post-Transplant Events

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

Bone Marrow Transplantation volume 48, pages 708–714 (2013)Cite this article

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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.

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Acknowledgements

We extend our gratitude to the blood and marrow transplant database managers who assisted in data collection for this work.

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Authors and Affiliations

  1. Department of Medicine, Division of Hematology, Mayo Clinic Graduate School of Medicine, Rochester, MN, USA

    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

  2. Blood and Marrow Transplantation Division, Center for Hematologic Malignancies, Oregon Health & Science University, Portland, OR, USA

    S G Holtan

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  1. L J DeCook
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Correspondence to S G Holtan.

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DeCook, L., Thoma, M., Huneke, T. et al. Impact of lymphocyte and monocyte recovery on the outcomes of allogeneic hematopoietic SCT with fludarabine and melphalan conditioning. Bone Marrow Transplant 48, 708–714 (2013). https://doi.org/10.1038/bmt.2012.211

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