Persistent cytotoxic T lymphocyte expansions after allogeneic haematopoietic stem cell transplantation: kinetics, clinical impact and absence of STAT3 mutations
Adult
Male
STAT3 Transcription Factor
Hematopoietic Stem Cell Transplantation
Graft vs Host Disease
Middle Aged
Gene Rearrangement, T-Lymphocyte
Survival Analysis
Immunophenotyping
Neoplasm Proteins
3. Good health
Leukemia, Large Granular Lymphocytic
Young Adult
03 medical and health sciences
0302 clinical medicine
Mutation
Humans
Female
Longitudinal Studies
T-Lymphocytes, Cytotoxic
DOI:
10.1111/bjh.13917
Publication Date:
2016-01-05T14:15:06Z
AUTHORS (16)
ABSTRACT
SummaryPeripheral expansion of cytotoxic T lymphocytes (CTL) derived from the graft in the initial stages of allogeneic haematopoietic stem cell transplantation (alloHSCT) immune recovery is a well‐known physiological event. The description of symptomatic large granular lymphocyte leukaemia in this setting may generate uncertainty, mostly in those cases in which the CTL expansion (CTLe) persists beyond the early transplantation period. We aimed to assess the nature of CTLe during the post‐alloHSCT period in 154 adult patients with a long‐term surveillance. We studied the longitudinal kinetics of those expansions, their relationship to clinical events, and their phenotypic and molecular features, including recently reported CTL leukaemia‐STAT3 mutations. Persistent relative CTLe cases are frequent (49%), related with thymoglobulin prophylaxis (P ≤ 0·001), acute graft‐versus‐host disease (GVHD, P = 0·02), and reduced intensity conditioning (P = 0·04). Absolute CTLe are scarce (9%) and related to chronic GVHD. T cell receptor rearrangement was reported as clonal and oligoclonal in the majority of patients with CTLe. The absence of STAT3 mutations and the CD8/CD4 declining longitudinal kinetics in the late period supports its benign nature, expressed clinically by the null detrimental impact of these expansions on post‐transplant outcome and/or serious infectious events.
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CITATIONS (18)
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