Correlation between immune reconstitution and clinical prognosis after allogeneic hematopoietic stem cell transplantation

Liu Die; Xia Xinlan; Zhu Jiuwei; An Lihong; Li Yan; Zhao Peng; Li Yanju; Li Mengxing; Wang Jishi; Lu Yinghao

doi:10.3760/j.issn.1673-4777.2026.03.017

Abstract：Objective To investigate the characteristics of immune reconstitution in patients after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and its correlation with clinical prognosis.Methods The clinical data of 208 patients who underwent allo-HSCT in the Department of Hematology,the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2022 were collected.Peripheral blood lymphocyte subsets and immunoglobulin(Ig)levels were measured before transplantation and at 30th,60th and 90th days after transplantation.The correlation between immune reconstitution and acute graft-versus-host disease(aGVHD)and overall survival was analyzed.Results The reconstitution of B cells and natural killer cells(NK cells)after allo-HSCT was faster,and the reconstitution of CD8+T cells was the second.The reconstitution of CD3+,CD4+T and Ig cells was slower than that after allo-HSCT.On the 30th day after allo-HSCT,the counts of CD4+T lymphocytes in the aGVHD group were higher than those in the non-aGVHD group[209(151,265)× 106/L vs 67(37,121)×106/L],while the counts of CD8+T lymphocytes and NK cells in the aGVHD group were lower than those in the non-aGVHD group[94(50,137)×106/L vs 185(104,280)× 106/L、158.0(113.8,306.8)×106/L vs 321.0(165.0,421.0)×106/L](all P＜0.05).The counts of CD3+T,CD8+T lymphocytes,B cells and NK cells in aGVHD group were lower than those in non-aGVHD group on the 60th day after allo-HSCT(all P＜0.05).On the 90th day after allo-HSCT,the counts of CD3+T,CD4+T,CD8+T lymphocytes and B cells in the aGVHD group were lower than those in the non-aGVHD group(all P＜0.05).The median time to aGVHD was the 41 st day after transplantation.The incidence of aGVHD was positively correlated with the counts of CD4+T lymphocytes,and negatively correlated with the counts of CD8+T lymphocytes,NK cells,IgG and IgA before the occurrence of aGVHD(all P＜0.05).The incidence of aGVHD was negatively correlated with the counts of CD3+T,CD8+T lymphocytes and B cells(all P＜0.05).The patients with higher peripheral blood CD4+cell counts(≥130.5 × 106/L)before the 41st day after transplantation had a better survival rate than those with lower peripheral blood CD4+cell counts(＜130.5 × 106/L)(P=0.016).Conclusion The immune reconstitution after allo-HSCT is correlated with the occurrence of aGVHD and overall survival,and the high CD4+T lymphocyte counts(≥130.5 × 106/L)in the early stage after allo-HSCT is associated with a better prognosis.