Naslov
Association of NIH organ cGVHD scores with blood lymphocyte subsets – a pilot study

Autori
Grković, Lana ; Pulanić, Dražen ; Perić, Zinaida ; Batinić, Drago ; Serventi Seiwerth, Ranka ; Mravak Stipetić, Marinka ; Bilić, Ervina ; Čeović, Romana ; Rajić, Ljubica ; Duraković, Nadira ; Matić, Nikolina ; Klepac Pulanić, Tajana ; Petriček, Igor ; Vukić, Tamara ; Ljubas, Dina ; Bilić, Ernest ; Dušek, Davorka ; Prenc, Ema ; Prah, Iva ; Bojanić, Ines ; Grce, Magdalena ; Zadro, Renata ; Vrhovac, Radovan ; Pavletic, Steven ; Nemet, Damir

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Bone Marrow Transplantation 50 / - , 2015, S183-S184

Skup
41st Annual Meeting of the European Society for Blood and Marrow Transplantation

Mjesto i datum
Istanbul, Turska, 22.03.2015. - 25.03.2015

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
NIH organ cGVHD scores ; blood lymphocyte subsets

Sažetak
Introduction: Immune reconstitution after allogeneic stem cell transplantation is influenced by many factors including chronic graft versus host disease (cGVHD). Although cGVHD is a complex multifactorial disease and there is no satisfactory therapy, distinct clinical syndromes with specific organ manifestations may exist, indicating subpathologies, which ultimately may require differently tailored therapies. To address this question, we tested the associations of immunological monitoring parameters with individual organs involvement and other key cGVHD characteristics. Materials (or patients) and methods: After establishment of a multidisciplinary cGVHD team in 2013 at the UHC Zagreb, patients were enrolled into the prospective cross-sectional study that included subspecialists exam, extended clinical assessments, and laboratory data collection at the time of study entry. Five lymphocyte subsets, T-cell (CD3þ, CD3þ CD4þhelper-Th, CD4þCD8þcytotoxic-Tc) B-cell (CD19þ) and natural killer (NK, CD16þCD56þ) cell were analyzed in peripheral blood by flow cytometry and correlated with demographic, transplant, cGVHD-related and laboratory data. Univariate analyses were undertaken to determine associations between lymphocytes subsets (high/low by median) and outcomes of interest. Results: Thirty adult and 3 pediatric patients were enrolled into the study. The median age was 40 years [9-72], 45% were female. Median time from transplant to study enrollment was 19 months [2-197]. The median time from cGVHD diagnosis to enrollment was 7 months [0.03-178] and the median time from transplant to cGVHD diagnosis was 10 months [1.8-29]. The majority of patients were transplanted for hematologic malignancies (85%). Eighteen patients (55%) underwent myeloablative conditioning and 45% received ATG, 70% had a related donor transplant and 64% received peripheral blood stem cells as graft source. Patients received a median of 2 [0–6] prior systemic therapies, 52% were on systemic immunosuppression, 55% had severe, 45% moderate NIH global score, 76% had previous acute GVHD and 85% were classified as classic. Patients who had previous acute GVHD had lower Th cells (P¼0.02). Patients with progressive cGVHD onset had lower Th (P¼0.009) and B cells (P¼0.0007). Higher Th, B and NK cells were found in patients presenting with classic cGVHD compared to overlap. As expected, patients who were receiving moderate or high immunosuppression had lower B (P¼0.005) and NK cells (P¼0.03). Patients who had documented infections since cGVHD diagnosis had lower Th (P¼0.01) cells. No significant associations were found between cGVHD severity (global NIH score) and activity, and subsets of lymphocytes. However, a statistically significant association was found between moderate or severe organ involvement (NIH score 2-3) and certain lymphocyte subsets in blood: higher NK (P¼0.04) in lung, lower B (P¼0.005) and NK (P¼0.05) in liver, lower B (P¼0.03) in mouth, and higher B cells in skin (P¼0.02) and joint (0.004) cGVHD involvement. No difference was found in T cell subsets depending on different organ involvement. Conclusion: Several individual organs had distinct associations with lymphocyte subset numbers in patients with cGVHD. Immune status is clearly influenced by the intensity of immunosuppression but not by the global NIH severity or activity. These data provide rationale for further studying of chronic GVHD biology in conjunction with distinct clinical syndromes. Disclosure of Interest: None declared.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

Napomena
Doi:10.1038/bmt.2015.29

POVEZANOST RADA