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ORIGINAL RESEARCH article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1552263
Lower Pre-conditioning Absolute Lymphocyte Counts Are Associated with Worse Outcomes in Haploidentical Stem Cell Transplantation with Myeloablative Regimen in Children
Provisionally accepted- Children's Hospital of Soochow University, Suzhou, China
Background: Anti-thymocyte globulin (ATG) is frequently administered for preventing graft-versus-host disease (GVHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). In patients with low absolute lymphocyte count (ALC) before conditioning, weight-based dosing of ATG may cause overexposure, negatively impacting prognosis.Method: Clinical data of patients with hematological malignancies undergoing haploidentical HSCT (haplo-HSCT) at the Children's Hospital of Soochow University from January 2020 to June 2023 were collected. This study primarily aims to investigate the association between pre-conditioning ALC and clinical outcomes in pediatric acute leukemia or myelodysplastic syndromes patients receiving myeloablative haplo-HSCT.We included 130 patients treated at the Children's Hospital of Soochow University from January 2020 to June 2023. According to the cutoff of 500/μl, patients were divided into high and low ALC groups. Patients in the high ALC group experienced a higher incidence of II-IV acute GVHD (30.2% versus 13.6%, P = 0.034), 3-year overall survival (OS) and relapse-free survival (RFS) rates (OS: 88.5% ± 3.7% versus 66.9% ± 7.9%, P = 0.013; RFS: 81.4% ± 4.1% versus 56.5% ± 8.1%, P < 0.001), and lower cumulative incidence of relapse (11.3% versus 27.4%, P = 0.013). Pre-conditioning ALC < 500/μl independently predicted worse OS, RFS, and higher relapse risk in multivariate analysis. However, there was no significant difference in immune reconstitution between the two groups.Pre-conditioning ALC was a significant prognostic factor in pediatric patients undergoing myeloablative haplo-HSCT. Further research is needed to explore whether pre-conditioning ALC can serve as a reference for adjusting ATG dosing.
Keywords: 2776, Table counts: 4, Figure counts: 15 Hematopoietic stem cell transplantation, haploidentical, Anti-thymocyte globulin, Absolute lymphocyte counts, pediatric
Received: 27 Dec 2024; Accepted: 07 Mar 2025.
Copyright: © 2025 Cui, Zhang, Du, Chai, Liang, Hu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Shaoyan Hu, Children's Hospital of Soochow University, Suzhou, China
Jie Li, Children's Hospital of Soochow University, Suzhou, China
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