Lymphocyte subsets recovery following allogeneic bone marrow transplantation (BMT): CD4+cell count and transplant-related mortality

To assess the kinetics of lymphocyte subset recovery, 758 allografted patients were monitored by surface markers (CD3, CD4, CD8, CD56), with a 5-year follow-up. The donor was a matched sibling donor (MSD) (n = 502) or an alternative donor (family mismatched or unrelated, AD) (n = 256). The stem cell source was bone marrow for all patients. CD4+ cell recovery was influenced-in univariate analysis-by three factors: donor type, patient age and GvHD. This was not the case for CD8+ and CD56+ cells. The median CD4+ cell count on day +35 after HSCT was 86/mu l. Patients achieving this CD4+ cell count had significantly lower transplant-related mortality (TRM) compared to patients who did not achieve this CD4+ cell count (20 vs 39%, P = 0.00001), due to a lower risk of lethal infections (24 vs 47%, P = 0.0003). In multivariate analysis MSD (RR 3.45, P = 0.0001) and recipient age less than 16 years (RR 3.23, P = 0.003) were significantly associated with a better CD4+ cell recovery. CD4+ counts on day +35 was predicted TRM (RR = 1.97, P = 0.0017) together with acute GvHD grade II-IV (RR = 1.59, P = 0.0097). No difference of TRM was observed for CD8+ and CD56+ cell counts.