Early and Long-Term Impaired T Lymphocyte Immune Reconstitution after Cord Blood Transplantation with Antithymocyte Globulin

Immune reconstitution is crucial to the success of allogeneic hematopoietic stem cell transplantation. Umbilical cord blood transplantation (UCBT) has been associated with delayed immune reconstitution. We characterized the kinetics and investigated the risk variables affecting recovery of the main lymphocyte subsets in 225 consecutive pediatric and adult patients (males, n = 126; median age, 15; range, .3 to 60; interquartile range, 4 to 35) who underwent myeloablative single UCBT between 2005 and 2015 for malignant and non-malignant disorders. Low CD4(+) and CD8(+) T cell counts were observed up to 12 months after UCBT. In contrast, B and natural killer cells recovered rapidly early after transplantation. In a multivariate regression model, factors favoring CD4(divided by) T cell recovery >= 200 cells/mu L were lower dose antithymocyte globulin (ATG) (hazard ratio [HR], 3.93; 95% confidence interval [CI], 2.3 to 5.83; P=.001), negative recipient cytomegalovirus (CMV) serostatus (HR, 3.76; 95% CI, 1.9 to 5.74; P=.001), and younger age (HR, 2.61; 95% CI, 1.01 to 3.47; P =.03). Factors favoring CD8(divided by) T cell recovery >= 200 cells/mu L were lower dose ATG (HR, 3.03; 95% CI, 1.4 to 5.1; P=.03) and negative recipient CMV serostatus (HR, 1.9; 95% CI, 1.63 to 2.15; P=.01). Our results demonstrate the significant negative impact of ATG on lymphocyte recovery. A reduction of the dose or omission of ATG could improve immune reconstitution and perhaps reduce opportunistic infections after UCBT. (c) 2017 American Society for Blood and Marrow Transplantation.