The impact of donor characteristics on the immune cell composition of mixture allografts of granulocyte-colony-stimulating factor-mobilized marrow harvests and peripheral blood harvests

Development and Validation of a Prediction Model for Severe Pre-Engraftment Syndrome During the Treatment of Unrelated Umbilical Cord Blood Transplantation in Pediatric Patients

BACKGROUND

Pre-engraftment syndrome (PES) is a common immune response during the early stages of umbilical cord blood transplantation (UCBT), but the severity classification of PES remains uncertain.

OBJECTIVES

To develop and validate a predictive model for PES severity in pediatric patients receiving UCBT.

STUDY DESIGN

This retrospective study (2017-2025) included 123 pediatric patients (training cohort) and 41 external validation cases. Uni- and multivariable analysis was conducted to assess the potential parameters affecting PES severity. Based on the multivariable Cox model, the optimal model's performance was illustrated using a nomogram and evaluated through discrimination and calibration.

RESULTS

Infused CD34+ counts (hazard ratio [HR]: 1.249, 95% confidence interval [CI]: 1.037-1.503, p < 0.05), donor chimerism on day 7 (HR: 1.025, 95% CI: 1.010-1.040, p < 0.05), and serum IL-6 level on symptoms onset (HR: 1.101, 95% CI: 1.000-1.123, p < 0.05) were identified as independent risk factors. The predictive performance of this nomogram model was evaluated by C-index and AUC, with C-index of 0.754 (95% CI: 0.693-0.815) and 9-day and 14-day AUC of 0.757 (95% CI: 0.655-0.859) and 0.856 (95% CI: 0.699-0.981), respectively. High-risk patients (score ≥104.9) had higher 9-day severe PES incidence (65.4% vs. 11.4%, p < 0.05) and Grade II-IV/III-IV aGVHD rates (84.2%/59.9% vs. 48.2%/28.2%, p < 0.05). External validation in an independent cohort (n = 41) displayed a C-index of 0.821 (95% CI: 0.689-0.953) and 14-day AUC of 0.933 (95% CI: 0.873-0.993).

CONCLUSION

This predictive model could predict the severity of PES in pediatric patients undergoing UCBT, thereby promoting preemptive treatment.

Monocytes in allo-HSCT with aged donors secrete IL-1/IL-6/TNF to increase the risk of GVHD and damage the aged HSCs

Aging is considered a critical factor of poor prognosis in allogenic hemopoietic stem cell transplantation (allo-HSCT). To elucidate the underlying mechanisms, we comprehensively reintegrated our clinical data from patients after allo-HSCT and public single-cell transcriptomic profile from post-allo-HSCT and healthy individuals, demonstrating that old donors were more prone to acute GVHD (aGVHD) with pronounced inflammation accumulation and worse overall survival (OS). We also found the presence of inflammation-related CXCL2+ HSC subpopulation during aging with significantly enriched pro-inflammatory pathways. Shifting attention to the HSC microenvironment, we deciphered that IL-1/IL-6 and TRAIL (i.e., TNFSF10) ligand‒receptor pair serves as the crucial bridge between CD14/CD16 monocytes and hematopoietic stem/progenitor cells (HSPCs). The profound upregulation of these signaling pathways during aging finally causes HSC dysfunction and lineage-biased differentiation. Our findings provide the theoretical basis for achieving tailored GVHD management and enhancing allo-HSCT regimens efficacy for aged donors.

Analysis of Cell Subsets in Donor Lymphocyte Infusions from HLA Identical Sibling Donors after Allogeneic Hematopoietic Cell Transplant

Donor lymphocytes infusions (DLIs) are a major therapeutic approach to treat relapse and mixed chimerism after allogeneic hematopoietic cell transplant (alloHCT). The impact of the composition regarding different cell subsets in the development of graft-versus-host disease (GVHD) is not fully understood. We performed a cell subsets analysis of 56 DLIs from fully HLA-compatible identical matched sibling donors (MSDs) in 36 alloHCT patients and studied its association with GVHD. A median of one DLI was infused per patient. Fourteen patients (38%) developed GVHD. The cell composition analysis of the first DLI (DLI1) showed that a high dose of B cells (P = .03) and CD27⁺ B cells (P < .01) was associated with GVHD. We identified DLI dose cutoff points for several cell populations above which GVHD was more frequent (CD8⁺ T_N >3 × 10⁶ cells/kg, CD27⁺ B cells >2.6 × 10⁶/kg, CD27⁺ NK >0.35 × 10⁶ cells/kg, and mononuclear cells >0.83 × 10⁸/kg). Noteworthy, the proportion of CD4⁺ naive T cells (T_N) or unselected T_N was not linked with GVHD and a DLI1 containing a higher dose of regulatory T cells was not protective for GVHD. We studied several transplant clinical variables and did not find any association with GVHD. Altogether, this study provides a comprehensive analysis of the cell populations in a DLI from MSDs and identifies potential key cell subsets, which provides insight for the understanding of GVHD after DLI.

Donor-Derived CD4+ T Cells and Human Herpesvirus 6B Detection After Allogeneic Hematopoietic Cell Transplantation

We sought to determine whether donor-derived human herpesvirus (HHV) 6B-specific CD4+ T-cell abundance is correlated with HHV-6B detection after allogeneic hematopoietic cell transplantation. We identified 33 patients who received HLA-matched, non-T-cell-depleted, myeloablative allogeneic hematopoietic cell transplantation and underwent weekly plasma polymerase chain reaction testing for HHV-6B for 100 days thereafter. We tested donor peripheral blood mononuclear cells for HHV-6B-specific CD4+ T cells. Patients with HHV-6B detection above the median peak viral load (200 copies/mL) received approximately 10-fold fewer donor-derived total or HHV-6B-specific CD4+ T cells than those with peak HHV-6B detection at ≤200 copies/mL or with no HHV-6B detection. These data suggest the importance of donor-derived immunity for controlling HHV-6B reactivation.

Monocyte subsets in bone marrow grafts may contribute to a low incidence of acute graft-vs-host disease for young donors

Young donors are associated with a lower cumulative incidence of acute graft‐vs‐host disease (aGVHD) after allogenic haematopoietic stem cell transplantation (allo‐HSCT) than old donors. Although grafts are harvested from healthy donors, it is unclear whether donor age is associated with aGVHD occurrence owing to its effect on cell compositions in grafts. Moreover, the differences in monocyte subsets in grafts between young and old donors and the association between monocyte subsets in bone marrow (BM) grafts and aGVHD remain to be elucidated. In the current study, non‐classical monocytes and the CD4⁺/CD8⁺ T cell ratio were remarkably decreased in BM grafts in donors <30 years old. Multivariate analysis further revealed that the level of non‐classical monocytes in BM grafts (≥0.31 × 10⁶/kg) was an independent risk factor for the occurrence of II‐IV aGVHD. In summary, our data indicate that non‐classical monocytes in BM grafts may help identify patients at high risk for aGVHD after allo‐HSCT. Although further validation is required, our results suggest that the low level of non‐classical monocytes and a low ratio of CD4⁺/CD8⁺ T cell in BM grafts may be correlated with the lower incidence of aGVHD in young donors.

A Pilot Study of Circulating Monocyte Subsets in Patients Treated with Stem Cell Transplantation for High-Risk Hematological Malignancies

Background and Objectives: Autologous and allogeneic stem cell transplantation is used in the treatment of high-risk hematological malignancies, and monocytes are probably involved in hematological reconstitution as well as posttransplant immunoregulation. The aim of our study was to investigate the levels of circulating monocyte subsets in allotransplant recipients. Materials and Methods: The levels of the classical, intermediate, and nonclassical monocyte subsets were determined by flow cytometry. Sixteen patients and 18 healthy controls were included, and the levels were analyzed during pretransplant remission (n = 13), early posttransplant during cytopenia (n = 9), and early reconstitution (n = 9). Results: Most patients in remission showed a majority of classical monocytes. The patients showed severe early posttransplant monocytopenia, but the total peripheral blood monocyte counts normalized very early on, and before neutrophil and platelet counts. During the first 7–10 days posttransplant (i.e., during cytopenia) a majority of the circulating monocytes showed a nonclassical phenotype, but later (i.e., 12–28 days posttransplant) the majority showed a classical phenotype. However, the variation range of classical monocytes was wider for patients in remission and during regeneration than for healthy controls. Conclusions: The total peripheral blood monocyte levels normalize at the very early stages and before neutrophil reconstitution after stem cell transplantation, and a dominance of classical monocytes is reached within 2–4 weeks posttransplant.

Who is the best haploidentical donor for acquired severe aplastic anemia? Experience from a multicenter study

BACKGROUND

Haploidentical transplantation has been proposed as an effective treatment for severe aplastic anemia (SAA). The majority of patients have more than one HLA-haploidentical donor. Herein, we compared the outcomes between different donor-recipient relationships for optimal haploidentical donor selection in acquired SAA.

METHODS

We conducted a multicenter study based on a registered database of 392 patients with SAA treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT) between 2006 and 2018. In total, 223 patients received grafts from father donors, 47 from mother donors, 91 from siblings, 29 from children, and 2 from collateral donors.

RESULTS

Of the 381 patients who survived more than 28 days, 379 (99.5%) recipients were engrafted. The 2-year overall survival (OS) was 86.6 ± 2.5%, 87.1 ± 4.9%, 84.3 ± 3.9%, and 92.2 ± 5.1% for recipients of father, mother, sibling, and child grafts, respectively, (P = 0.706). The 2-year failure-free survival (FFS) was 82.8 ± 2.7%, 86.7 ± 5.1%, 80.8 ± 4.2%, and 92.5 ± 5.1% for recipients of father, mother, sibling, and child grafts, respectively, (P = 0.508). There was no difference in the incidence of either acute or chronic graft-versus-host disease (GVHD) among the different donor sources in multivariate analyses. There were also no differences in the OS or FFS among the different donor sources in the Cox regression analysis. However, OS was significantly better in the patients with a shorter history of aplastic anemia (< 12 months), better performance status (ECOG scores 0-1), or moderate graft mononuclear cell (MNC) counts (6-10 × 10⁸/kg), and in female recipients with male donors. The FFS was also higher in patients with a shorter history of aplastic anemia (< 12 months) and better performance status (ECOG scores 0-1).

CONCLUSIONS

Fathers, mothers, siblings, and children are all suitable haploidentical donors for patients with SAA.

Relationship of Cell Compositions in Allografts with Outcomes after Haploidentical Transplantation for Acquired Severe Aplastic Anemia: Effects of CD34+ and CD14+ Cell Doses

Background

The dose of certain cell types in allografts affects engraftment kinetics and clinical outcomes after allogeneic stem cell transplantation (SCT). Hence, the present study investigated the association of cell compositions in allografts with outcomes after unmanipulated haploidentical SCT (haplo-SCT) for patients with acquired severe aplastic anemia (SAA).

Methods

A total of 131 patients with SAA who underwent haplo-SCT were retrospectively enrolled. Cell subsets in allografts were determined using flow cytometry. To analyze the association of cellular compositions and outcomes, Mann-Whitney U nonparametric tests were conducted for patient age, sex, weight, human leukocyte antigen mismatched loci, ABO-matched status, patient ABO blood type, donor-recipient sex match, donor-recipient relationship, and each graft component. Multivariate analysis was performed using logistic regression to determine independent influence factors involving dichotomous variables selected from the univariate analysis.

Results

A total of 126 patients (97.7%) achieved neutrophil engraftment, and 121 patients (95.7%) achieved platelet engraftment. At 100 days after transplantation, the cumulative incidence of II-IV acute graft-versus-host disease (GVHD) was 32.6%. After a median follow-up of 842 (range: 124-4110) days for surviving patients, the cumulative incidence of total chronic GVHD at 3 years after transplantation was 33.7%. The probability of overall survival at 3 years was 83.0%. Multivariate analysis showed that higher total doses of CD14⁺ (P = 0.018) and CD34⁺ cells (P < 0.001) were associated with a successful platelet engraftment. A successful platelet was associated with superior survival (P < 0.001). No correlation of other cell components with outcomes was observed.

Conclusions

These results provide evidence and explain that higher doses of CD34⁺ and CD14⁺ cells in haploidentical allografts positively affect platelet engraftment, contributing to superior survival for patients with SAA.

The impact of donor characteristics on the invariant natural killer T cells of granulocyte-colony-stimulating factor-mobilized marrow grafts and peripheral blood grafts

INTRODUCTION

Invariant natural killer T cells (iNKTs) are a rare but vital subset of immunomodulatory T cells and play an important role in allogeneic hematopoietic stem cell trans-plantation (HSCT). The association of donor characteristics with the number and frequency of the iNKTs subsets in allografts remains poorly understood. In this paper, we prospectively investigate the association of donor characteristics with iNKTs dose and frequency in granulocyte-colony-stimulating factor (G-CSF) mobilized marrow and peripheral blood harvests.

MATERIALS AND METHODS

100 bone marrow (BM) units and 100 peripheral blood (PB) units from 100 healthy donors were examined. Parameters including donor age, sex, weight, height, BMI and blood count [including white blood cells (WBCs), lymphocytes and monocytes] at three time points [donor's steady state before G-CSF administration, the day of G-BM harvesting and the day of G-PB apheresis] were analyzed to explore the impact of donor characteristics on iNKTs composition in BM and PB grafts.

RESULTS

Multivariate analysis showed monocyte counts before G-BM harvest could predict higher frequency of iNKTs in WBC (OR = 2.593, 95%CI: 1.128-5.961, p = 0.025), higher total CD4+ iNKTs dose (OR = 2.250, 95%CI: 1.011-5.008, p = 0.047) and higher total iNKTs dose (OR = 2.662, 95%CI: 1.187-5.970, p = 0.017) in mixture allografts.

DISCUSSION

The results suggested that monocyte counts pre G-BM harvest could predict the yield of total CD4+ iNKTs and total iNKTs in mixture allografts. The male and older donors were associated with a higher dose of total CD4- iNKTs in mixture allografts.

Association between B7-H1 and cervical cancer: B7-H1 impairs the immune response in human cervical cancer cells

The aim of the present study was to determine the preliminary mechanism of action of B7 homolog 1 (B7-H1) and investigate the association between B7-H1 and cervical cancer. The expression of B7 family proteins was measured in cervical cancer cells. Cervical cancer cells were co-cultured with T lymphocytes. An ELISA assay was subsequently conducted to analyze cytokine concentrations in the supernatants of the cultured T cells in cervical cancer cells and B7-H1 downregulated cells. Levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor-α mRNA in mice injected with cervical cancer cells or B7-H1 downregulated cells were measured by reverse transcription-quantitative polymerase chain reaction. It was determined that cervical cancer cells express high levels of B7-H1, whereas the normal cervical epithelium does not express B7-H1. When co-cultured with T lymphocytes, cervical cancer cells were involved in the inhibition of lymphocyte activation. When B7-H1 was downregulated using a lentivirus, the proliferation ability did not change compared with cervical cancer cells, whereas the soluble factors secreted by T cells differed between cervical cancer cells and B7-H1 downregulated cells. In an animal model, injected B7-H1 downregulated cervical cancer cells elicited a more intense immune response, whereas cervical cancer cells had the wild immune response. Therefore, the results of the present study demonstrate that B7-H1 mediates the low immunogenicity of cervical cancer and is not attacked by the immune system.

Donor and recipient age, gender and ABO incompatibility regardless of donor source: validated criteria for donor selection for haematopoietic transplants

Prior data indicate similar outcomes after transplants from human leukocyte antigen (HLA)-haplotype-matched relatives, HLA-identical siblings and HLA-matched unrelated donors. We used our prospective data set to answer a clinically important question: who is the best donor for a person with acute leukaemia transplanted in first complete remission. Patients were randomly divided into training (n=611) and validation (n=588) sets. A total of 1199 consecutive subjects received a transplant from an HLA-haplotype-matched relative using granulocyte colony-stimulating factor and anti-thymocyte globulin (n=685) or an HLA-identical sibling (n=514); 3-year leukaemia-free survivals (LFSs) were 75 and 74% (P=0.95), respectively. The multivariate model identified three major risk factors for transplant-related mortality (TRM): older donor/recipient age, female-to-male transplants and donor-recipient ABO major-mismatch transplants. A risk score was developed based on these three features. TRMs were 8%, 15% and 31% for subjects with scores of 0-1, 2 and 3, respectively, (P<0.001). Three-year LFSs were 78%, 74% and 58%, respectively, (P=0.003). The risk score was validated in an independent cohort. In conclusion, our data confirm donor source is not significantly correlated with transplant outcomes. Selection of the best donor needs to consider donor-recipient age, matching for gender and ABO incompatibility among persons with acute leukaemia receiving related transplants under our transplant modality.

How do we choose the best donor for T-cell-replete, HLA-haploidentical transplantation?

In haploidentical stem cell transplantations (haplo-SCT), nearly all patients have more than one donor. A key issue in the haplo-SCT setting is the search for the best donor, because donor selection can significantly impact the incidences of acute and chronic graft-versus-host disease, transplant-related mortality, and relapse, in addition to overall survival. In this review, we focused on factors associated with transplant outcomes following unmanipulated haplo-SCT with anti-thymocyte globulin (ATG) or after T-cell-replete haplo-SCT with post-transplantation cyclophosphamide (PT/Cy). We summarized the effects of the primary factors, including donor-specific antibodies against human leukocyte antigens (HLA); donor age and gender; killer immunoglobulin-like receptor-ligand mismatches; and non-inherited maternal antigen mismatches. We also offered some expert recommendations and proposed an algorithm for selecting donors for unmanipulated haplo-SCT with ATG and for T-cell-replete haplo-SCT with PT/Cy.

The impact of donor characteristics on the immune cell composition of second allografts in Chinese people

BACKGROUND

The association of the donor characteristics with the immune cell composition in second allografts remains poorly understood. In this study, we investigated retrospectively the effects of the donor characteristics on the immune cell composition in second allografts.

STUDY DESIGN AND METHODS

The immune cell composition in second allografts of granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood harvests from 100 healthy donors (male, 47, female, 53; median age, 39 years old) who underwent a second-time donation were correlated with their donor characteristics.

RESULTS

The median counts of CD3(+) T cells, CD4(+) T cells, CD8(+) T cells, CD3(+) CD4(-) CD8(-) T cells and monocytes in allografts were 150·17 × 10(6) /kg, 82·57 × 10(6) /kg, 48·02 × 10(6) /kg and 24·97 × 10(6) /kg, respectively. Multivariate analysis showed that the number of lymphocytes and platelets pre-first collection of G-CSF mobilized blood (FM) was strongly associated with the number of total lymphocytes (for lymphocytes, P = 0·003; for platelets, P = 0·012), CD3(+) T cells (for lymphocytes, P = 0·009; for platelets, P = 0·004) and CD3(+) CD4(+) T cells (for lymphocytes, P = 0·035; for platelets, P = 0·004) in the second allograft. The donor's BMI was negatively related to the number of CD3(+) T cells (P = 0·022) and CD3(+) CD4(+) T cells (P = 0·026) in the second allograft. The donor weight was negatively associated with the number of CD3(+) CD4(-) CD8(-) T cells (P = 0·015) in the second allograft, while the pre-FM white blood cell count showed a positive correlation (P = 0·009).

CONCLUSION

The results demonstrate the impact of the donor characteristics, including pre-FM platelet count and lymphocyte count, donor BMI and weight, on the immune cell composition in the second allograft.