Peritransplant palifermin use and lymphocyte recovery after T-cell replete, matched related allogeneic hematopoietic cell transplantation

Allogeneic hematopoietic cell transplantation (allo-HCT) is often the only curative option for people with otherwise fatal hematologic malignancies. As the number of allo-HCT procedures continues to increase [1], it is increasingly clear that a major obstacle to success is delayed immune recovery, which puts patients at risk for a wide variety of opportunistic infections [2-8]. Additionally, rapid early lymphocyte recovery may serve as a surrogate predictor of better transplant outcomes. Robust recovery of absolute lymphocyte counts (ALC) early after transplantation is associated with improved survival following autologous, sibling, unrelated bone marrow, peripheral blood, and umbilical cord blood transplantation [9-15]. There is a clear need to develop strategies to accelerate and improve immune reconstitution (IR). Several novel approaches have been successfully tested in preclinical animal models and early human clinical trials. These include pretransplant androgen ablation, keratinocyte growth factor (KGF), and a p53 inhibitor or post-transplant administration of interleukin (IL)-7, IL-15, growth hormone, or insulin-like growth factor-1 [16-20].