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Dynamical System Modeling of Immune Reconstitution after Allogeneic Stem Cell Transplantation Identifies Patients at Risk for Adverse Outcomes.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2015 Jul; Vol. 21 (7), pp. 1237-45. Date of Electronic Publication: 2015 Apr 04. - Publication Year :
- 2015
-
Abstract
- Systems that evolve over time and follow mathematical laws as they evolve are called dynamical systems. Lymphocyte recovery and clinical outcomes in 41 allograft recipients conditioned using antithymocyte globulin (ATG) and 4.5-Gy total body irradiation were studied to determine if immune reconstitution could be described as a dynamical system. Survival, relapse, and graft-versus-host disease (GVHD) were not significantly different in 2 cohorts of patients receiving different doses of ATG. However, donor-derived CD3(+) cell reconstitution was superior in the lower ATG dose cohort, and there were fewer instances of donor lymphocyte infusion (DLI). Lymphoid recovery was plotted in each individual over time and demonstrated 1 of 3 sigmoid growth patterns: Pattern A (n = 15) had rapid growth with high lymphocyte counts, pattern B (n = 14) had slower growth with intermediate recovery, and pattern C (n = 10) had poor lymphocyte reconstitution. There was a significant association between lymphocyte recovery patterns and both the rate of change of donor-derived CD3(+) at day 30 after stem cell transplantation (SCT) and clinical outcomes. GVHD was observed more frequently with pattern A, relapse and DLI more so with pattern C, with a consequent survival advantage in patients with patterns A and B. We conclude that evaluating immune reconstitution after SCT as a dynamical system may differentiate patients at risk of adverse outcomes and allow early intervention to modulate that risk.<br /> (Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Female
Graft vs Host Disease etiology
Graft vs Host Disease immunology
Graft vs Host Disease mortality
Hematologic Neoplasms immunology
Hematologic Neoplasms mortality
Hematologic Neoplasms pathology
Humans
Immunosuppressive Agents therapeutic use
Lymphocyte Transfusion statistics & numerical data
Male
Middle Aged
Nonlinear Dynamics
Prognosis
Prospective Studies
Recurrence
Risk
Siblings
Survival Analysis
Transplantation, Homologous
Unrelated Donors
Whole-Body Irradiation
Antilymphocyte Serum therapeutic use
Graft vs Host Disease prevention & control
Hematologic Neoplasms therapy
Hematopoietic Stem Cell Transplantation adverse effects
Models, Immunological
Transplantation Conditioning
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6536
- Volume :
- 21
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 25849208
- Full Text :
- https://doi.org/10.1016/j.bbmt.2015.03.011