Early Lymphocytic Recovery After Allogeneic Transplation of Hemopoetic Stem Cells in Patients with Hematologic Malignancies – Single Center Experience

Early Lymphocytic Recovery After Allogeneic Transplation of Hemopoetic Stem Cells in Patients with Hematologic Malignancies – Single Center Experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Early Lymphocytic Recovery After Allogeneic Transplation of Hemopoetic Stem Cells in Patients with Hematologic Malignancies – Single Center Experience Kameliya Kostadinova, Krasen Venkov, Ivan Tonev, Yonka Lazarova, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4874233/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Allogeneic hematopoietic stem cell transplantation (AlloHSCT) is a therapeutic method for the treatment of many malignant and non-malignant hematological diseases but is still associated with significant morbidity and mortality. Disease relapse recurrence and non-relapse mortality (NRM) remain the main causes of failure from AlloHSCT. The identification of the risk factors associated with this continue to be a subject of extensive scientific research. The aim of our study was to identify the prognostic significance of the early lymphocyte recovery (ELR), presented as absolute lymphocyte count (ALC) for the outcome of AlloHSCT. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 INTRODUCTION AlloHSCT (allogeneic hematopoietic stem cell transplantation) is a proven therapeutic modality for the treatment of malignant and benign hematological diseases but is still associated with significant morbidity and mortality [ 1 , 2 , 3 ]. The main causes of failure remain disease relapse and treatment-related mortality. The antileukemic effect of AlloHSCT is a result of two key biological processes: the elimination of residual, chemosensitive tumor cells from the conditioning chemotherapy and the antileukemic effect of the graft (graft versus leukemia, GVL). The importance of the GVL effect described and highlighted by the Seattle group in 1970 and highlighted by the success of non-myeloablative allogeneic transplantation [ 4 , 5 ]. The effector mechanism of GVL and GvHD is complex and not yet fully understood [ 6 ]. Medicine continues to search for risk factors directly related to improving the outcome of AlloHSCT. Crucial to improving overall survival and reducing relapse-free mortality after AlloHSCT is timely and functionally adequate immune reconstitution. A surrogate marker for it is the recovery of the donor lymphoid system represented by lymphocytes circulating in the peripheral blood. The role of ELR as a biologically relevant prognostic marker for transplant outcome has been investigated in a number of studies [ 7 , 8 , 9 , 10 , 11 ]. AIM OF THE STUDY The aim of our study was to identify the prognostic significance of the early lymphocyte recovery (ELR), presented as absolute lymphocyte count (ALC) for the outcome of AlloSCT. MATERIALS AND METHODS 1. Patients The medical records of 96 patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) and acute lymphoblastic leukemia (ALL) who received AlloHSCT between 2017–2021 years. Demographic, clinical, and laboratory data were obtained from the hospital information system (HIS). Patients were selected based on the following criteria. Inclusion criteria were: 1. Patients aged ≥ 18 years. 2. Diagnosis: AML, MDS, ALL. 3. Indicated to proceed to AlloHSCT. 4. Signed informed consent. 5. Documented engraftment. 6. Survival 30 days after AlloHSCT. Exclusion criteria used: 1. Patients with acute promyelocytic leukemia. 2. Patients with relapsed or de novo acute leukemia after first AlloHSCT. 4. Patients with primary graft failure, graft rejection, poor graft function, according to generally accepted definitions [ 12 ]. 2. Methods The choice of regimen intensity was at the discretion of the treating team based on the patient's age and comorbidity index. MAC-eligible patients with AML and MDS were preferentially conditioned with a busulfan-based regimen (Bu 3.6 mg/kg for 4 days), and those with ALL with a total body irradiation (TBI)-based regimen (10–12 Gy). Patients transplanted from a match unrelated donor (MUD) undergo “in vivo” T-cell depletion with antithymocyte globulin (ATG). All patients received standard anti-infective prophylaxis (Ciprofloxacin, Fluconazole, Acyclovir), prophylaxis for veno-occlusive disease (VOD) with Ursodeoxycolic acid and immunosuppression with cyclosporin A (CycA) + methotrexate (MTX) / mycophenolic acid (MMF) + tacrolimus (TAC) / post-transplant cyclophosphamide (PTCy) + MMF + TAC/CycA +ММF. 3. Statistical analysis Statistical analysis includes assessment of quantitative and categorical variables with absolute and relative frequencies. The type of the distribution was established with a Kolmogorov–Smirnov test. A chi (χ²) square analysis (Fisher's exact test) was applied to test the relationship between categorical variables. A non-parametric Mann-Whitney test was used for testing the significance of the difference between two average values from two independent samples. Cox regression analysis as well as log-rank test (Mantel-Cox) were applied to search for significant factors related to survival and other time-evolving events. Mean and median time-to-event were assessed by Kaplan-Meier’s method. Values of p < 0.05 were considered significant. Analysis was performed by IBM SPSS v. 22. RESULTS 1. Characteristics of the patients and transplantation program The baseline characteristics of all 96 patients included in the analysis are presented in Tables 1 . The median follow-up was 54.7 months (95% CI 45.86–63.6). The median age was 43 years (32–52), ranging from 19 to 68 years. The leading indication for AlloHSCT was AML, in 63.5%. Patients' physical status and comorbidity related to AlloHSCT were assessed with ECOG-PS [ 13 ] and HSCT-CI [ 14 ]. More than half of the patients were transplanted in first remission CR1 -53.1% and calculated DRI [ 15 ]- low/intermediate − 54.2%. Regarding the profile of the transplant program, 55.2% of patients were transplanted from a MUD. 55.2% underwent myeloablative conditioning. GvHD prophylaxis with antithymocyte/antilymphocyte globulin (ATG) was used in 46.9% of patients included in the analysis. ATG was the choice of GvHD prophylaxis in unrelated donor transplants. For 8.3% of MUD patients ATG was not available at time of transplantation. Table 1 Characteristics of the patients (n = 96) Characteristics Number (n) Percentage (%) Age < 40 42 43.8% ≥ 40 54 56.3% Recipient sex Male 65 67.7% Female 31 32.3% Donor sex Male 55 57.3% Female 41 42.7% Diagnoses AML 61 63.5% MDS 5 5.2% ALL 30 31.3% ECOG PS 0–1 93 96.9% 2 3 3.1% HSCT CI 0–2 89 92.7% 3–5 7 7.3% DRI Low + Intermediate 52 54.2% High + Very high 44 45.8% Response rate CR1 51 53.1% CR2/CR3 16 16.7% RR 29 30.2% ABO - incompatibility Minor 22 22.9% Major 16 16.7% Bidirectional 5 5.2% Compatible 53 55.2% HLA-match MRD 26 27.1% MUD 53 55,2% Haplo 17 17.7% Sex ratio donor-recipient Female donor- male recipient 25 26.0% others 54 74.0% Conditioning MAC 53 55.2% RIC 43 44.8% TBI - based 32 33.3% Bu -based 59 61.5% ATG –containing 45 46.90% Abbreviations: AML - acute myeloid leukemia; MDS - myelodysplastic syndrome; ECOG PS - Eastern Cooperative Oncology Group Performance Status; HSCT CI - Hematopoietic Stem Cell Transplantation Comorbidity Index; DRI – disease risk index; CR – complete remission; RR – relapsed/refractory disease; MRD – matched related donor; MURD – matched unrelated donor; Halpo – haploidentical related donor; MAC – myeloablative conditioning; RIC-reduced intensity conditioning; TBI- total body irradiation; Bu – busulfan; ATG – antithymocyte globulin; GVHD – graft-versus-host reaction; aGVHD – acute graft-versus-host reaction; cGVHD – chronic graft-versus-host disease. All patients received G-CSF mobilized hematopoietic stem cells from peripheral blood. 2. Early lymphocyte recovery and absolute lymphocyte count Assessment of ELR as ALC was performed on D + 21 and D + 30. Considering that the lowest normal reference value for ALC (0.5 x 10 9 /l) is not clinically relevant for this patient population, we used Cox regression analysis to test the significance of ALC factors – D + 21 and D + 30 for assessment of OS. Only D + 21 proved to be a significant factor for OS (p = 0.004, HR = 0.998, 95% CI 0.996–0.999). The function thus obtained from the Cox analysis was transferred into a ROC curve to determine the best cut-off value of D + 21 in terms of OS (Figure №1). The area under the curve is 0.797 (at a population value of 0.5) and is statistically significant (p < 0.001). The limit value of the function was determined to be 0.5376, which corresponds to ALC 0.220× 10 9 /l of D + 21. Based on the created new variable, the patients were grouped and evaluated in two groups – DLR with ALC < 0.220 x 10 9 /l and ELR with ALC ≥ 0.220 x 10 9 /l. 3. The role of early lymphocyte recovery for transplant outcome Stratified by lymphocyte recovery, the median OS for ELR was not reached compared with 225 days for DLR (p < 0.001), Fig. 2 . In terms of PFS, it was also demonstrated a significant difference in the two cohorts, the median PFS for ELR was not reached compared to 196 days for the DLR group (p < 0.000), Fig. 3 . The median CIR was not reached for patients with ELR compared to those with DLR, which was 393 days (p = 0.022), Fig. 4 . Median NRM was not reached in both groups, but time to event was significantly longer for patients with ELR, 2261 days compared to 1889 days for the DLR group, (p = 0.003), Fig. 5 . The results at 1st and 3rd year of AlloSCT stratified by lymphocyte recovery are presented in Tables 2 . Significantly better results were reported both at 1st and 3rd year in patients who achieved ELR at D + 21 after stem cell infusion. Table 2 Transplant-related outcomes at 1st year and 3rd year Variable ALC + 21 < 0,220 х 10 9 ALC + 21 ≥ 0,220 х 10 9 p OS 1st year 35.7% 75.9% p < 0.000 PFS 1st year 33.3% 70.4% p < 0.000 CIR 1st year 49.4% 25.2% p < 0.022 NRM 1st year 39.1% 8.1% p = 0.003 OS 3rd year 29.5% 67.8% p < 0.000 PFS 3rd year 27.1% 60.2% p < 0.000 CIR 3rd year 53.0% 30.1% p < 0.022 NRM 3rd year 39.1% 12.9% p = 0.003 3. Factors associated with early lymphocyte recovery A statistically significant relationship was proved between ALC D + 21 and DRI, response rate before AlloHSCT and the choice of a haploidentical donor – Table 3 . Table 3 Patient and transplant program characteristics stratified by ALC ALC D + 21 < 220 х 10 9 /L ALC D + 21 ≥ 220 х 10 9 /L N % N % p Age < 40 16 38.1% 26 61.9% 0.325 ≥ 40 26 48.1% 28 51.9% Sex Male 27 41.5% 38 58.5% 0.527 Female 15 48.4% 16 51.6% Diagnoses AML 24 39.3% 37 58.3% 0.651 МDS 2 40.0% 3 75.0% ALL 16 53.6% 14 50.0% ECOG PS 0–1 39 41.9% 54 59.7% 0.08 2 3 100.0% 0 0.0% HCT CI 0–2 37 41.6% 52 60.3% 0.234 3–5 5 71.4% 2 28.6% DRI Low + Intermediate 17 32.7% 35 67.3% 0.018 High + Very high 25 56.8% 19 43.2% Response rate CR1 17 33.3% 34 66.7% 0.045 CR2/CR3 7 43.8% 9 56.2% RR 18 62.1% 11 37.9% ABO - incompatibility minor 11 50.0% 11 50.0% 0.303 major 6 37.5% 10 62.5% bidirectional 4 76.5% 1 23.5% compatible 21 45.7% 32 54.3% HLA-match MRD 10 38.5% 16 51.5% 0.524 MURD 19 35.8% 34 64.2% 0.083 Haplo 13 76.5% 4 27.5% 0.003 Sex ratio donor-recipient Female donor – male recipient 11 44.0% 14 56.0% 0.997 Conditioning MAC 21 39.6% 32 60.4% 0.365 RIC 21 48.8% 22 51.2% TBI - based 16 50.0% 16 50.0% 0.303 Bu - based 25 42.4% 34 57.6% ATG - containing 23 51.1% 22 48.9% 0.172 Graft composition, represented by the median of transfused CD34 + and CD3 + donor cells, was not identified as a statistically significant factor correlating with lymphocyte recovery, p = 0.0547 and p = 0.0842, respectively. We performed a univariable and multivariable analysis to estimate the relationship between ELR and these factors in the terms of OS. The univariable model identifies as a significant – ECOG PS, HCT CI, DRI and response rate before AlloHSCT, of them only DRI was confirmed by the multivariable analysis (p = 0.04, HR 1.926, 95.0% CI 1.030–3.603). We studied the degree of cytokine response in the preengrafment period, assessed by the maximum value of serum CRP (max CRP) during the first seven days after AlloHSCT and maximum body temperature (max BT) - Fig. 6 . So far it is known that CRP may be a net surrogate marker for early disease/syndrome leading to the development of a/cGVHD and eventual NRM [ 17 ]. Our results show that high values of max CRP (normal values up to 5 mg/L for our laboratory) in this period lead to delayed early lymphocytic recovery. The median max CRP in the group of patients with ALC D + 21 below 0.220 x 10 9 /L is 139.5 mg/L, in contrast of only 27.5 mg/L for patients with ALC D + 21 above 0.220 x 10 9 /L (p = 0.001). 4. Analysis of post transplantation complications and mortality according to lymphocyte reconstitution. The frequency of aGvHD was statistically significantly higher in patients with DLR, Table.8. To assess the relationship between ALC and aGvHD in the context of OS, we divided the sample into two groups: with and without manifestations of aGvHD. In both groups, the higher median survival of patients with ELR was seen. In the aGvHD group, significance was borderline (p = 0.055), while in the non-aGvHD group, the difference was significant (p = 0.001), Figs. 7 and 8 . Median OS for patients with ELR was not reached in both groups. For ELR patients with registered aGvHD, it was 208 days, compared to 320 days for those without. We can conclude that patients with ELR have a lower incidence of aGvHD and better survival, regardless of the development or not of an acute graft reaction. The frequency of cGvHD was significantly higher in the ELR group 79.2% vs. 20.8% for the DLR (p = 0.035), respectively. It’s seen that all patients with mild chronic graft reaction have ELR, without this being confirmed as a statistically significant fact, Table 4 . To evaluate the relationship between ALC and cGvHD in terms of OS, we divided the sample into two groups: with and without cGvHD. In both groups, the higher median survival of patients with ELR was seen, Figs. 9 and 10 , (p = 0.040 in the group with cGvHD, p = 0.003 in the group without). Median OS for patients with GvHD was not reached in both groups. For patients with GvHD with recorded cGvHD, it was 208 days, compared to 417 days for those without. We can conclude that patients with ELR have a better survival, despite the higher frequency of cGvHD registered in them. Table 4 Post transplantation complications stratified based on D + 21 lymphocyte recovery ALC D + 21 < 0,220 х 10 9 /L ≥ 0,220 х 10 9 /L p N % N % aGvHD 25 56.8% 19 43.2% 0.014 1–2 15 53.6% 13 46.4% 0.565 3–4 10 62.5% 6 37.5% cGvHD 5 20.8% 19 79.2% 0.035 mild 0 0.0% 9 100.0% 0.065 moderate 2 22.2% 7 77.8% severe 3 50.0% 3 50.0% CMV reactivation 25 48.1% 27 51.9% 0.35 In terms of CMV reactivation, the results are similar in both groups - ELR and DLR, Table 4 . One of the explanations of this is the fact that ALC could’n represent the speed of immune, recovery of CMV-specific cytotoxic T-lymphocytes. We couldn’t estimate the significance of ERL/DLR for other types of viral infection such as adenovirus and BKV, we have only 2 patients with proven adenovirus infection and 6 cases with BKV cystitis. The immunohematology recovery, followed dynamically in both groups, are presented in Table 5 . A significant delay in neutrophil and platelet recovery was observed in the group of DLR. As well as lower values of WBC, Hb, PLT, NK-cells, Neu at the end of the first month of AlloSCT, without statistical significance for NK-cells and Neu. Table 5 ELR and hematological recovery ALC D + 21 < 0,220 х 10 9 /L ≥ 0,220 х 10 9 /L Median Percentile 25 Percentile 75 Median Percentile 25 Percentile 75 p Neu recovery in days 17 15 20 15 13 19 0.042 PLT recovery in days 19 15 25 14 12 15 < 0.001 NK -cells / µl + 1 month 150.5 62.0 362.0 176.5 96.0 322.0 0.626 WBC х 10 9 /L + 1 month 3.4 2.1 4.3 4.9 3.4 5.8 0.006 Hb х g/L + 1 month 98 88 109 113 103 121 < 0.001 PLT х 10 9 /L + 1 month 86 30 141 148 114 199 < 0.001 Neu х 10 9 /L + 1 month 2 1 3 3 2 4 0.156 DISCUSSION A number of studies investigate the influence of lymphocyte recovery and immune reconstitution on the outcome of AlloSCT. Most of them include a small number of patients are limited to a specific disease type, donor type, conditioning regimen, and graft source. Le Blank [ 16 ] and Michaelis [ 17 ] analyzed only patients with AML, Kumar S et al. [ 18 ] considered only cases of bone-marrow transplantation, and Amandine Le Bourgeois [ 19 ] - umbilical cord transplantation. They covered a wide range of time points for post-transplant assessment (days 21 to 100 after AlloHSCT) and offered different threshold values for defining low ALC (0.175 x 10 9 /l cells to 0.5 x 109/l). Our initial analysis on the role of ELR for the outcome of AlloHSCT, in assessing OS, defined a “cut off” value for ALC of 0.220× 10 9 /L and time point D + 21 from transplantation as an independent prognostic factor for prolonged OS. Rigoni et al [ 20 ] demonstrated the association of ELR on D + 21 with higher OS in a patient population with a profile similar to ours, choosing an arbitrary cut-off value for analysis of ALC of 0.300× 10 9 /L. Kim et al [ 21 ] identified as a cutoff value with prognostic significance for OS - ALC − 0.350 x 10 9 /L on D + 21. Kumar et al. concluded that ALC below 0.175 x 10 9 /L on D + 21 was a predictor of relapse risk in transplanted ALL patients. The study of the relationship between ELR and other clinical endpoints assessing the effectiveness and safety of AlloHSCT – PFS, CIR, NRM proved that patients with ELR on D + 21 had longer relapse-free survival and time-delayed NRM-related event. Regarding NRM, the medians were not reached in both groups, but the time to event was statistically significantly longer for patients with ELR. In contrast to Rigoni et al., after median follow-up of 20 months, their study demonstrated a significantly longer disease-free survival, but not NRM, for patients with ALC > 0.300× 10 9 /L on D + 21. Kim et al. demonstrated a significantly longer risk-free survival and a lower relapse rate in patients with ALC > 0.350× 10 9 /L on D + 21, but a non-significant difference for NRM. Kumar et al. reported a significantly longer risk-free survival and lower relapse rate in patients with ALC > 0.175× 10 9 /L on D + 21 but did not assess NRM. This is the first study to identify risk factors for delayed lymphocyte recovery - DRI, the response to AlloHSCT and the severity of the cytokine response in the pre-engraftment period. Known factors leading to DLR are HLA-incompatible donor, dose of infused CD 34 + cells, administration of ATG, administration of G-CSF to stimulate engraftment, aGvHD [ 22 , 23 , 18 ]. Our results confirm that the choice of a haploidentical donor is an unfavorable factor for ELR − 8 (72.7%) of patients with a haploidentical donor had DLR (p = 0.029). The influence of the haploidentical donor on lymphocyte recovery is well known [ 24 ]. Delayed immune reconstitution in haploidentical transplantation is a distinctive feature of the immunopathogenesis of this type of procedure. Unlike Kim et al. [ 25 ] and Damlaj et al. [ 26 ], in our study the relationship between the amount of infused CD34 + cells and DLV was not confirmed. In terms of OS only DRI was confirmed by the multivariable analysis as a significant risk factor for DLR (p = 0.04, HR 1.926, 95.0% CI 1.030–3.603). Analysis of data regarding the significance of ELR in terms of complications in the post-transplant period reached key conclusions regarding aGvHD, cGvHD and their association with survival. ELR correlates with the clinical manifestation of an acute graft reaction, as also established by Rigoni et al. Analysis stratifying patients based on median D + 21 lymphocyte recovery also showed a statistically significant difference in median D + 21 ALC in patients with and without aGvHD manifestations. These results translated into improved survival for patients with ELR both with overt aGvHD and without documented reactivity. This raises the question of conducting additional research aimed at clarifying the dynamics of immune reconstitution and identifying the lymphocyte subpopulations involved in the immunopathogenesis of aGvHD and the role of immunoregulatory cells. We also found a higher frequency of cGvHD in patients with ELR, in contrast to Rigoni et al., they only proved a correlation between ALC and the incidence of aGvHD. Despite the higher frequency of cGvHD for ELR, their median OS was not reached. The improved OS in the ELR group at a higher incidence of cGvHD confirms the protective role of cGvHD and supports the hypothesis of Damlaj et al that ELR may be a surrogate marker for GVL. A significant association between early lymphocyte recovery, presented in the context of LD-index (Lymphopenia duration), and cGvHD was also observed by Yanagi and colleagues [ 27 ]. Further studies of lymphocyte subpopulation composition in the setting of cGvHD are needed to elucidate the immunopathogenesis of these results. Our study confirms that ELR can be a statistically proven surrogate marker for stable graft engraftment, tracking the time to hematologic recovery for neutrophils and platelets (and D + 30 hematological recovery from AlloSCT). A drawback of our study is that the role of the graft source for immunohematologic after AlloSCT could not be evaluated because patients who received bone marrow stem cells were excluded from the study due to their extremely small number. CONCLUSION We can conclude that ELR presented as ALB of D+21≥ 0.220 x 10 9 /L is a clinically significant prognostic factor for the outcome of transplantation - universal, accessible, easily measurable and cheap. It could serve as a starting point already in the early post-transplant period to initiate risk-adapted immunomodulatory strategies in patients with high-very high DRI and those not transplanted in CR1. Declarations Institutional Review Board Statement This study was approved by the Specialized Hospital for Active Treatment of Hematological Diseases (SHATHD) in Sofia; all patients signed an informed consent form. Human Ethics and Consent to Participate declarations: not applicable Funding: No funding Author Contribution K.K. wrote the manuscript and made the analysis. E.N. did the statistics. I.T. and K.V. did the data collection and processing. Y.L. did the literature search. G.M was responsible for concept and design of the study.All authors reviewed the manuscript. 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Damlaj M, Ghazi S, Mashaqbeh W, Gmati G et al. Lymphocyte recovery is an independent predictor of relapse in allogeneic hematopoietic cell transplantation recipients for acute leukemia. World J Transplant. 2017 Aug 24;7(4):235-242. doi: 10.5500/wjt.v7.i4.235. PMID: 28900606; PMCID: PMC5573899. Yanagi, M., Kobayashi, R., Matsushima, S., Hori, D., Kodama, K., Suzuki, D. and Kobayashi, K. (2022), Early reconstitution of lymphocytes after allogenic hematopoietic stem cell transplantation affects chronic graft-versus-host disease. Pediatrics International, 64: e15222. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4874233","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":348193418,"identity":"8bd086e2-6c74-45fb-bbf9-701b2e297ca9","order_by":0,"name":"Kameliya Kostadinova","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAnklEQVRIiWNgGAWjYLACHgYbBgMGBjaStKSRruUwCVoMjncnPnhTcV7eXCKB7eEXorScObvZcM6Z24Y7ZySwG8sQo0VyRu42ad6224wbzhxgk5YgQcs5e+K18EuAtRxI3HC8gU3yA1FaeMB+SU7e2d7YbkyMDgY29t6NwBCzs93OzHzs4Q+i9CAAYwMzD4lagJpItWUUjIJRMApGBgAA6akyTbWTCN0AAAAASUVORK5CYII=","orcid":"","institution":"Specialized hospital for active treatment of hematological diseases (SHATHD)","correspondingAuthor":true,"prefix":"","firstName":"Kameliya","middleName":"","lastName":"Kostadinova","suffix":""},{"id":348193419,"identity":"9225feb8-b36e-475c-83f7-675c866894fa","order_by":1,"name":"Krasen Venkov","email":"","orcid":"","institution":"Specialized hospital for active treatment of hematological diseases (SHATHD)","correspondingAuthor":false,"prefix":"","firstName":"Krasen","middleName":"","lastName":"Venkov","suffix":""},{"id":348193420,"identity":"b8056bc2-dcca-46c9-834a-8de42f9838b6","order_by":2,"name":"Ivan Tonev","email":"","orcid":"","institution":"Specialized hospital for active treatment of hematological diseases (SHATHD)","correspondingAuthor":false,"prefix":"","firstName":"Ivan","middleName":"","lastName":"Tonev","suffix":""},{"id":348193421,"identity":"ac9a647b-0037-4958-b384-31e7810148fd","order_by":3,"name":"Yonka Lazarova","email":"","orcid":"","institution":"Specialized hospital for active treatment of hematological diseases (SHATHD)","correspondingAuthor":false,"prefix":"","firstName":"Yonka","middleName":"","lastName":"Lazarova","suffix":""},{"id":348193422,"identity":"d3f599cf-d909-4e55-853f-ead5e60b158f","order_by":4,"name":"Emilia Naseva","email":"","orcid":"","institution":"Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”","correspondingAuthor":false,"prefix":"","firstName":"Emilia","middleName":"","lastName":"Naseva","suffix":""},{"id":348193423,"identity":"8bdffcc6-61b7-40cc-a9ef-4464bdea9b6a","order_by":5,"name":"Georgi Mihaylov","email":"","orcid":"","institution":"Specialized hospital for active treatment of hematological diseases (SHATHD)","correspondingAuthor":false,"prefix":"","firstName":"Georgi","middleName":"","lastName":"Mihaylov","suffix":""}],"badges":[],"createdAt":"2024-08-07 11:11:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4874233/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4874233/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66116501,"identity":"39491a64-f0b8-4007-bdbf-305e7578aa87","added_by":"auto","created_at":"2024-10-08 00:41:54","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23490,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve determining cut-off value of D+21 for OS based on Cox Proportional hazard function model with area under the curve 0.797. The blue line is Cumulative hazard function corresponding to D+21 as a factor for OS.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/b9ed823fafe6cf822a6abf74.jpg"},{"id":66118485,"identity":"03e982fb-c0c8-46a6-b055-894dd688d8f3","added_by":"auto","created_at":"2024-10-08 01:05:55","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31422,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOS, stratified based on lymphocyte recovery at D+21\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/64615d4946efc7b93444b5b9.jpg"},{"id":66116508,"identity":"98069e4f-68c3-4414-97d9-50176fab01c4","added_by":"auto","created_at":"2024-10-08 00:41:55","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":31589,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePFS, stratified based on lymphocyte recovery at D+21\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/346d31a50cbc90f63dbc210c.jpg"},{"id":66116507,"identity":"591c25bf-b069-4f01-8af2-7077855ac621","added_by":"auto","created_at":"2024-10-08 00:41:55","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":30840,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCIR, stratified based on lymphocyte recovery at D+21\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/9ada8a134c74bd67edbded11.jpg"},{"id":66116845,"identity":"03d1c958-8015-4f66-ad66-c0422e05f4a1","added_by":"auto","created_at":"2024-10-08 00:49:55","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":28471,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNRM, stratified based on lymphocyte recovery at D+21\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/1edb14c63c615e63c5770581.jpg"},{"id":66116849,"identity":"abe4ab26-b3c4-4386-832c-fc197f5f3609","added_by":"auto","created_at":"2024-10-08 00:49:55","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":21047,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003emax CRP stratified by lymphocyte count (p=0.001)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/f7c142b76af97dd959ba8d6e.jpg"},{"id":66118000,"identity":"62d8fcf6-7ab7-4250-b801-50c445749a9d","added_by":"auto","created_at":"2024-10-08 00:57:55","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":25838,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOS stratified by D+21 lymphocyte recovery for aGvHD patients\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/81c0ff74efea9888079d135e.jpg"},{"id":66116504,"identity":"ca74b7a9-7e55-499e-8b6a-fb234f835ffb","added_by":"auto","created_at":"2024-10-08 00:41:55","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":29904,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOS stratified by D+21 lymphocyte recovery for patients without aGvHD\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/fcbaa9ff8183b4999c60f0e6.jpg"},{"id":66116502,"identity":"007c82fc-3fe7-4ea4-9181-3bb7426b1552","added_by":"auto","created_at":"2024-10-08 00:41:54","extension":"jpg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":26464,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOS stratified by D+21 lymphocyte recovery for cGvHD patients\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"9.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/0870751113646d71a51482ea.jpg"},{"id":66116846,"identity":"1c374b6a-25e8-406b-945c-e2d2865c11e8","added_by":"auto","created_at":"2024-10-08 00:49:55","extension":"jpg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":25936,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOS stratified by D+21 lymphocyte recovery for patients without cGvHD\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"10.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/b6a6511f921ced1e26c8021a.jpg"},{"id":73738855,"identity":"34946b93-ce2c-4efe-8073-a0493f04a288","added_by":"auto","created_at":"2025-01-14 07:38:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1589085,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4874233/v1/a7de8fc0-69e8-430b-b0b4-23f73a39f2dc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEarly Lymphocytic Recovery After Allogeneic Transplation of Hemopoetic Stem Cells in Patients with Hematologic Malignancies – Single Center Experience\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION ","content":"\u003cp\u003eAlloHSCT (allogeneic hematopoietic stem cell transplantation) is a proven therapeutic modality for the treatment of malignant and benign hematological diseases but is still associated with significant morbidity and mortality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The main causes of failure remain disease relapse and treatment-related mortality. The antileukemic effect of AlloHSCT is a result of two key biological processes: the elimination of residual, chemosensitive tumor cells from the conditioning chemotherapy and the antileukemic effect of the graft (graft versus leukemia, GVL). The importance of the GVL effect described and highlighted by the Seattle group in 1970 and highlighted by the success of non-myeloablative allogeneic transplantation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The effector mechanism of GVL and GvHD is complex and not yet fully understood [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Medicine continues to search for risk factors directly related to improving the outcome of AlloHSCT. Crucial to improving overall survival and reducing relapse-free mortality after AlloHSCT is timely and functionally adequate immune reconstitution. A surrogate marker for it is the recovery of the donor lymphoid system represented by lymphocytes circulating in the peripheral blood. The role of ELR as a biologically relevant prognostic marker for transplant outcome has been investigated in a number of studies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eAIM OF THE STUDY\u003c/h2\u003e \u003cp\u003eThe aim of our study was to identify the prognostic significance of the early lymphocyte recovery (ELR), presented as absolute lymphocyte count (ALC) for the outcome of AlloSCT.\u003c/p\u003e \u003c/div\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1. Patients\u003c/h2\u003e \u003cp\u003eThe medical records of 96 patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) and acute lymphoblastic leukemia (ALL) who received AlloHSCT between 2017\u0026ndash;2021 years. Demographic, clinical, and laboratory data were obtained from the hospital information system (HIS). Patients were selected based on the following criteria. Inclusion criteria were: 1. Patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years. 2. Diagnosis: AML, MDS, ALL. 3. Indicated to proceed to AlloHSCT. 4. Signed informed consent. 5. Documented engraftment. 6. Survival 30 days after AlloHSCT. Exclusion criteria used: 1. Patients with acute promyelocytic leukemia. 2. Patients with relapsed or de novo acute leukemia after first AlloHSCT. 4. Patients with primary graft failure, graft rejection, poor graft function, according to generally accepted definitions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2. Methods\u003c/h3\u003e\n\u003cp\u003eThe choice of regimen intensity was at the discretion of the treating team based on the patient's age and comorbidity index. MAC-eligible patients with AML and MDS were preferentially conditioned with a busulfan-based regimen (Bu 3.6 mg/kg for 4 days), and those with ALL with a total body irradiation (TBI)-based regimen (10\u0026ndash;12 Gy). Patients transplanted from a match unrelated donor (MUD) undergo \u0026ldquo;in vivo\u0026rdquo; T-cell depletion with antithymocyte globulin (ATG). All patients received standard anti-infective prophylaxis (Ciprofloxacin, Fluconazole, Acyclovir), prophylaxis for veno-occlusive disease (VOD) with Ursodeoxycolic acid and immunosuppression with cyclosporin A (CycA)\u0026thinsp;+\u0026thinsp;methotrexate (MTX) / mycophenolic acid (MMF)\u0026thinsp;+\u0026thinsp;tacrolimus (TAC) / post-transplant cyclophosphamide (PTCy)\u0026thinsp;+\u0026thinsp;MMF\u0026thinsp;+\u0026thinsp;TAC/CycA +ММF.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3. Statistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis includes assessment of quantitative and categorical variables with absolute and relative frequencies. The type of the distribution was established with a Kolmogorov\u0026ndash;Smirnov test. A chi (χ\u0026sup2;) square analysis (Fisher's exact test) was applied to test the relationship between categorical variables. A non-parametric Mann-Whitney test was used for testing the significance of the difference between two average values from two independent samples. Cox regression analysis as well as log-rank test (Mantel-Cox) were applied to search for significant factors related to survival and other time-evolving events. Mean and median time-to-event were assessed by Kaplan-Meier\u0026rsquo;s method. Values of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered significant. Analysis was performed by IBM SPSS v. 22.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e1. Characteristics of the patients and transplantation program\u003c/h2\u003e \u003cp\u003eThe baseline characteristics of all 96 patients included in the analysis are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The median follow-up was 54.7 months (95% CI 45.86\u0026ndash;63.6). The median age was 43 years (32\u0026ndash;52), ranging from 19 to 68 years. The leading indication for AlloHSCT was AML, in 63.5%. Patients' physical status and comorbidity related to AlloHSCT were assessed with ECOG-PS [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and HSCT-CI [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. More than half of the patients were transplanted in first remission CR1 -53.1% and calculated DRI [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]- low/intermediate \u0026minus;\u0026thinsp;54.2%. Regarding the profile of the transplant program, 55.2% of patients were transplanted from a MUD. 55.2% underwent myeloablative conditioning. GvHD prophylaxis with antithymocyte/antilymphocyte globulin (ATG) was used in 46.9% of patients included in the analysis. ATG was the choice of GvHD prophylaxis in unrelated donor transplants. For 8.3% of MUD patients ATG was not available at time of transplantation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the patients (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge; 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRecipient sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDonor sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDiagnoses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eECOG PS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHSCT CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u0026thinsp;+\u0026thinsp;Intermediate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u0026thinsp;+\u0026thinsp;Very high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eResponse rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCR1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCR2/CR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eABO - incompatibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMajor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBidirectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompatible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHLA-match\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMRD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMUD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55,2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHaplo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex ratio donor-recipient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale donor-\u003c/p\u003e \u003cp\u003emale recipient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eConditioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTBI - based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBu -based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eATG \u0026ndash;containing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.90%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: AML - acute myeloid leukemia; MDS - myelodysplastic syndrome; ECOG PS - Eastern Cooperative Oncology Group Performance Status; HSCT CI - Hematopoietic Stem Cell Transplantation Comorbidity Index; DRI \u0026ndash; disease risk index; CR \u0026ndash; complete remission; RR \u0026ndash; relapsed/refractory disease; MRD \u0026ndash; matched related donor; MURD \u0026ndash; matched unrelated donor; Halpo \u0026ndash; haploidentical related donor; MAC \u0026ndash; myeloablative conditioning; RIC-reduced intensity conditioning; TBI- total body irradiation; Bu \u0026ndash; busulfan; ATG \u0026ndash; antithymocyte globulin; GVHD \u0026ndash; graft-versus-host reaction; aGVHD \u0026ndash; acute graft-versus-host reaction; cGVHD \u0026ndash; chronic graft-versus-host disease.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll patients received G-CSF mobilized hematopoietic stem cells from peripheral blood.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2. Early lymphocyte recovery and absolute lymphocyte count\u003c/h2\u003e \u003cp\u003eAssessment of ELR as ALC was performed on D\u0026thinsp;+\u0026thinsp;21 and D\u0026thinsp;+\u0026thinsp;30. Considering that the lowest normal reference value for ALC (0.5 x 10\u003csup\u003e9\u003c/sup\u003e/l) is not clinically relevant for this patient population, we used Cox regression analysis to test the significance of ALC factors \u0026ndash; D\u0026thinsp;+\u0026thinsp;21 and D\u0026thinsp;+\u0026thinsp;30 for assessment of OS. Only D\u0026thinsp;+\u0026thinsp;21 proved to be a significant factor for OS (p\u0026thinsp;=\u0026thinsp;0.004, HR\u0026thinsp;=\u0026thinsp;0.998, 95% CI 0.996\u0026ndash;0.999). The function thus obtained from the Cox analysis was transferred into a ROC curve to determine the best cut-off value of D\u0026thinsp;+\u0026thinsp;21 in terms of OS (Figure №1). The area under the curve is 0.797 (at a population value of 0.5) and is statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The limit value of the function was determined to be 0.5376, which corresponds to ALC 0.220\u0026times; 10\u003csup\u003e9\u003c/sup\u003e/l of D\u0026thinsp;+\u0026thinsp;21. Based on the created new variable, the patients were grouped and evaluated in two groups \u0026ndash; DLR with ALC\u0026thinsp;\u0026lt;\u0026thinsp;0.220 x 10\u003csup\u003e9\u003c/sup\u003e/l and ELR with ALC\u0026thinsp;\u0026ge;\u0026thinsp;0.220 x 10\u003csup\u003e9\u003c/sup\u003e/l.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3. The role of early lymphocyte recovery for transplant outcome\u003c/h2\u003e \u003cp\u003eStratified by lymphocyte recovery, the median OS for ELR was not reached compared with 225 days for DLR (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn terms of PFS, it was also demonstrated a significant difference in the two cohorts, the median PFS for ELR was not reached compared to 196 days for the DLR group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.000), Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe median CIR was not reached for patients with ELR compared to those with DLR, which was 393 days (p\u0026thinsp;=\u0026thinsp;0.022), Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMedian NRM was not reached in both groups, but time to event was significantly longer for patients with ELR, 2261 days compared to 1889 days for the DLR group, (p\u0026thinsp;=\u0026thinsp;0.003), Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results at 1st and 3rd year of AlloSCT stratified by lymphocyte recovery are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Significantly better results were reported both at 1st and 3rd year in patients who achieved ELR at D\u0026thinsp;+\u0026thinsp;21 after stem cell infusion.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTransplant-related outcomes at 1st year and 3rd year\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALC\u0026thinsp;+\u0026thinsp;21\u0026thinsp;\u0026lt;\u0026thinsp;0,220 х 10\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eALC\u0026thinsp;+\u0026thinsp;21\u0026thinsp;\u0026ge;\u0026thinsp;0,220 х 10\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOS 1st year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePFS 1st year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCIR 1st year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRM 1st year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOS 3rd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePFS 3rd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCIR 3rd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRM 3rd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3. Factors associated with early lymphocyte recovery\u003c/h2\u003e \u003cp\u003eA statistically significant relationship was proved between ALC D\u0026thinsp;+\u0026thinsp;21 and DRI, response rate before AlloHSCT and the choice of a haploidentical donor \u0026ndash; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient and transplant program characteristics stratified by ALC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eALC\u003c/p\u003e \u003cp\u003eD\u0026thinsp;+\u0026thinsp;21\u0026thinsp;\u0026lt;\u0026thinsp;220 х 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eALC\u003c/p\u003e \u003cp\u003eD\u0026thinsp;+\u0026thinsp;21\u0026thinsp;\u0026ge;\u0026thinsp;220 х 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e61.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDiagnoses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAML\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.651\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eМDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eECOG PS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e59.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHCT CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u0026thinsp;+\u0026thinsp;Intermediate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e67.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u0026thinsp;+\u0026thinsp;Very high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eResponse rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCR1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCR2/CR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e56.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e37.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eABO - incompatibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eminor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emajor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e62.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebidirectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecompatible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e54.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHLA-match\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMRD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMURD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e64.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHaplo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e27.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex ratio donor-recipient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale donor \u0026ndash; male recipient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e56.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eConditioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTBI - based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBu - based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e57.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eATG - containing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGraft composition, represented by the median of transfused CD34\u0026thinsp;+\u0026thinsp;and CD3\u0026thinsp;+\u0026thinsp;donor cells, was not identified as a statistically significant factor correlating with lymphocyte recovery, p\u0026thinsp;=\u0026thinsp;0.0547 and p\u0026thinsp;=\u0026thinsp;0.0842, respectively.\u003c/p\u003e \u003cp\u003eWe performed a univariable and multivariable analysis to estimate the relationship between ELR and these factors in the terms of OS. The univariable model identifies as a significant \u0026ndash; ECOG PS, HCT CI, DRI and response rate before AlloHSCT, of them only DRI was confirmed by the multivariable analysis (p\u0026thinsp;=\u0026thinsp;0.04, HR 1.926, 95.0% CI 1.030\u0026ndash;3.603).\u003c/p\u003e \u003cp\u003eWe studied the degree of cytokine response in the preengrafment period, assessed by the maximum value of serum CRP (max CRP) during the first seven days after AlloHSCT and maximum body temperature (max BT) - Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. So far it is known that CRP may be a net surrogate marker for early disease/syndrome leading to the development of a/cGVHD and eventual NRM [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Our results show that high values of max CRP (normal values up to 5 mg/L for our laboratory) in this period lead to delayed early lymphocytic recovery. The median max CRP in the group of patients with ALC D\u0026thinsp;+\u0026thinsp;21 below 0.220 x 10\u003csup\u003e9\u003c/sup\u003e/L is 139.5 mg/L, in contrast of only 27.5 mg/L for patients with ALC D\u0026thinsp;+\u0026thinsp;21 above 0.220 x 10\u003csup\u003e9\u003c/sup\u003e/L (p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e4. Analysis of post transplantation complications and mortality according to lymphocyte reconstitution.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe frequency of aGvHD was statistically significantly higher in patients with DLR, Table.8. To assess the relationship between ALC and aGvHD in the context of OS, we divided the sample into two groups: with and without manifestations of aGvHD. In both groups, the higher median survival of patients with ELR was seen. In the aGvHD group, significance was borderline (p\u0026thinsp;=\u0026thinsp;0.055), while in the non-aGvHD group, the difference was significant (p\u0026thinsp;=\u0026thinsp;0.001), Figs.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e. Median OS for patients with ELR was not reached in both groups. For ELR patients with registered aGvHD, it was 208 days, compared to 320 days for those without. We can conclude that patients with ELR have a lower incidence of aGvHD and better survival, regardless of the development or not of an acute graft reaction.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe frequency of cGvHD was significantly higher in the ELR group 79.2% vs. 20.8% for the DLR (p\u0026thinsp;=\u0026thinsp;0.035), respectively. It\u0026rsquo;s seen that all patients with mild chronic graft reaction have ELR, without this being confirmed as a statistically significant fact, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. To evaluate the relationship between ALC and cGvHD in terms of OS, we divided the sample into two groups: with and without cGvHD. In both groups, the higher median survival of patients with ELR was seen, Figs.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e and \u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e, (p\u0026thinsp;=\u0026thinsp;0.040 in the group with cGvHD, p\u0026thinsp;=\u0026thinsp;0.003 in the group without). Median OS for patients with GvHD was not reached in both groups. For patients with GvHD with recorded cGvHD, it was 208 days, compared to 417 days for those without. We can conclude that patients with ELR have a better survival, despite the higher frequency of cGvHD registered in them.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost transplantation complications stratified based on D\u0026thinsp;+\u0026thinsp;21 lymphocyte recovery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eALC D\u0026thinsp;+\u0026thinsp;21\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0,220 х 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;0,220 х 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eaGvHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecGvHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e79.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCMV reactivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e51.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn terms of CMV reactivation, the results are similar in both groups - ELR and DLR, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. One of the explanations of this is the fact that ALC could\u0026rsquo;n represent the speed of immune, recovery of CMV-specific cytotoxic T-lymphocytes.\u003c/p\u003e \u003cp\u003eWe couldn\u0026rsquo;t estimate the significance of ERL/DLR for other types of viral infection such as adenovirus and BKV, we have only 2 patients with proven adenovirus infection and 6 cases with BKV cystitis.\u003c/p\u003e \u003cp\u003eThe immunohematology recovery, followed dynamically in both groups, are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. A significant delay in neutrophil and platelet recovery was observed in the group of DLR. As well as lower values of WBC, Hb, PLT, NK-cells, Neu at the end of the first month of AlloSCT, without statistical significance for NK-cells and Neu.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eELR and hematological recovery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003eALC D\u0026thinsp;+\u0026thinsp;21\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0,220 х 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;0,220 х 10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentile 25\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentile 75\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePercentile 25\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePercentile 75\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeu recovery in days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT recovery in days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNK -cells / \u0026micro;l\u0026thinsp;+\u0026thinsp;1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e362.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e176.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e322.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.626\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC х 10\u003csup\u003e9\u003c/sup\u003e/L\u0026thinsp;+\u0026thinsp;1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb х g/L\u0026thinsp;+\u0026thinsp;1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT х 10\u003csup\u003e9\u003c/sup\u003e/L\u0026thinsp;+\u0026thinsp;1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeu х 10\u003csup\u003e9\u003c/sup\u003e/L\u0026thinsp;+\u0026thinsp;1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eA number of studies investigate the influence of lymphocyte recovery and immune reconstitution on the outcome of AlloSCT. Most of them include a small number of patients are limited to a specific disease type, donor type, conditioning regimen, and graft source. Le Blank [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and Michaelis [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] analyzed only patients with AML, Kumar S et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] considered only cases of bone-marrow transplantation, and Amandine Le Bourgeois [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] - umbilical cord transplantation. They covered a wide range of time points for post-transplant assessment (days 21 to 100 after AlloHSCT) and offered different threshold values for defining low ALC (0.175 x 10\u003csup\u003e9\u003c/sup\u003e/l cells to 0.5 x 109/l).\u003c/p\u003e \u003cp\u003eOur initial analysis on the role of ELR for the outcome of AlloHSCT, in assessing OS, defined a \u0026ldquo;cut off\u0026rdquo; value for ALC of 0.220\u0026times; 10\u003csup\u003e9\u003c/sup\u003e/L and time point D\u0026thinsp;+\u0026thinsp;21 from transplantation as an independent prognostic factor for prolonged OS. Rigoni et al [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] demonstrated the association of ELR on D\u0026thinsp;+\u0026thinsp;21 with higher OS in a patient population with a profile similar to ours, choosing an arbitrary cut-off value for analysis of ALC of 0.300\u0026times; 10\u003csup\u003e9\u003c/sup\u003e/L. Kim et al [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] identified as a cutoff value with prognostic significance for OS - ALC \u0026minus;\u0026thinsp;0.350 x 10\u003csup\u003e9\u003c/sup\u003e/L on D\u0026thinsp;+\u0026thinsp;21. Kumar et al. concluded that ALC below 0.175 x 10\u003csup\u003e9\u003c/sup\u003e/L on D\u0026thinsp;+\u0026thinsp;21 was a predictor of relapse risk in transplanted ALL patients.\u003c/p\u003e \u003cp\u003eThe study of the relationship between ELR and other clinical endpoints assessing the effectiveness and safety of AlloHSCT \u0026ndash; PFS, CIR, NRM proved that patients with ELR on D\u0026thinsp;+\u0026thinsp;21 had longer relapse-free survival and time-delayed NRM-related event. Regarding NRM, the medians were not reached in both groups, but the time to event was statistically significantly longer for patients with ELR. In contrast to Rigoni et al., after median follow-up of 20 months, their study demonstrated a significantly longer disease-free survival, but not NRM, for patients with ALC\u0026thinsp;\u0026gt;\u0026thinsp;0.300\u0026times; 10\u003csup\u003e9\u003c/sup\u003e/L on D\u0026thinsp;+\u0026thinsp;21. Kim et al. demonstrated a significantly longer risk-free survival and a lower relapse rate in patients with ALC\u0026thinsp;\u0026gt;\u0026thinsp;0.350\u0026times; 10\u003csup\u003e9\u003c/sup\u003e/L on D\u0026thinsp;+\u0026thinsp;21, but a non-significant difference for NRM. Kumar et al. reported a significantly longer risk-free survival and lower relapse rate in patients with ALC\u0026thinsp;\u0026gt;\u0026thinsp;0.175\u0026times; 10\u003csup\u003e9\u003c/sup\u003e/L on D\u0026thinsp;+\u0026thinsp;21 but did not assess NRM.\u003c/p\u003e \u003cp\u003eThis is the first study to identify risk factors for delayed lymphocyte recovery - DRI, the response to AlloHSCT and the severity of the cytokine response in the pre-engraftment period. Known factors leading to DLR are HLA-incompatible donor, dose of infused CD 34\u0026thinsp;+\u0026thinsp;cells, administration of ATG, administration of G-CSF to stimulate engraftment, aGvHD [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur results confirm that the choice of a haploidentical donor is an unfavorable factor for ELR \u0026minus;\u0026thinsp;8 (72.7%) of patients with a haploidentical donor had DLR (p\u0026thinsp;=\u0026thinsp;0.029). The influence of the haploidentical donor on lymphocyte recovery is well known [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Delayed immune reconstitution in haploidentical transplantation is a distinctive feature of the immunopathogenesis of this type of procedure. Unlike Kim et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and Damlaj et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], in our study the relationship between the amount of infused CD34\u0026thinsp;+\u0026thinsp;cells and DLV was not confirmed.\u003c/p\u003e \u003cp\u003eIn terms of OS only DRI was confirmed by the multivariable analysis as a significant risk factor for DLR (p\u0026thinsp;=\u0026thinsp;0.04, HR 1.926, 95.0% CI 1.030\u0026ndash;3.603).\u003c/p\u003e \u003cp\u003eAnalysis of data regarding the significance of ELR in terms of complications in the post-transplant period reached key conclusions regarding aGvHD, cGvHD and their association with survival. ELR correlates with the clinical manifestation of an acute graft reaction, as also established by Rigoni et al. Analysis stratifying patients based on median D\u0026thinsp;+\u0026thinsp;21 lymphocyte recovery also showed a statistically significant difference in median D\u0026thinsp;+\u0026thinsp;21 ALC in patients with and without aGvHD manifestations. These results translated into improved survival for patients with ELR both with overt aGvHD and without documented reactivity. This raises the question of conducting additional research aimed at clarifying the dynamics of immune reconstitution and identifying the lymphocyte subpopulations involved in the immunopathogenesis of aGvHD and the role of immunoregulatory cells.\u003c/p\u003e \u003cp\u003eWe also found a higher frequency of cGvHD in patients with ELR, in contrast to Rigoni et al., they only proved a correlation between ALC and the incidence of aGvHD. Despite the higher frequency of cGvHD for ELR, their median OS was not reached. The improved OS in the ELR group at a higher incidence of cGvHD confirms the protective role of cGvHD and supports the hypothesis of Damlaj et al that ELR may be a surrogate marker for GVL. A significant association between early lymphocyte recovery, presented in the context of LD-index (Lymphopenia duration), and cGvHD was also observed by Yanagi and colleagues [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Further studies of lymphocyte subpopulation composition in the setting of cGvHD are needed to elucidate the immunopathogenesis of these results.\u003c/p\u003e \u003cp\u003eOur study confirms that ELR can be a statistically proven surrogate marker for stable graft engraftment, tracking the time to hematologic recovery for neutrophils and platelets (and D\u0026thinsp;+\u0026thinsp;30 hematological recovery from AlloSCT).\u003c/p\u003e \u003cp\u003eA drawback of our study is that the role of the graft source for immunohematologic after AlloSCT could not be evaluated because patients who received bone marrow stem cells were excluded from the study due to their extremely small number.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eWe can conclude that ELR presented as ALB of D+21\u0026ge; 0.220 x 10\u003csup\u003e9\u003c/sup\u003e/L is a clinically significant prognostic factor for the outcome of transplantation - universal, accessible, easily measurable and cheap. It could serve as a starting point already in the early post-transplant period to initiate risk-adapted immunomodulatory strategies in patients with high-very high DRI and those not transplanted in CR1.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInstitutional Review Board Statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis study was approved by the Specialized Hospital for Active Treatment of Hematological Diseases (SHATHD) in Sofia; all patients signed an informed consent form.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHuman Ethics and Consent to Participate declarations: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding:\u003c/em\u003e\u003c/strong\u003e No funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eK.K. wrote the manuscript and made the analysis. E.N. did the statistics. I.T. and K.V. did the data collection and processing. Y.L. did the literature search. G.M was responsible for concept and design of the study.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to express our gratitude to all the medical specialists and diagnostic laboratories of the SHATHD for their active involvement, assistance, and compassionate care, which were instrumental in the successful completion of this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eH.K.Mahmoud, A.M. Elhaddad, O.A. Fahmy, Samra M.A. Abdelfattah RM, Y.H.El-Nahass, et al.Allogeneic hematopoietic stem cell transplantation for non-malignant hematological disorders J. Adv. Res., 6(2015), pp.449-458.\u003c/li\u003e\n\u003cli\u003eFallen PR, McGreavey L, Madrigal JA, et al. Factors affecting reconstitution of the T cell compartment in allogeneic haematopoietic cell transplant recipients. Bone Marrow Transplant. 2003; 32:1001-1014.\u003c/li\u003e\n\u003cli\u003eAppelbaum FR. Hematopoietic-cell transplantation at 50. N Engl J Med 2007; 357:1472\u0026ndash;5\u003c/li\u003e\n\u003cli\u003eWeiden PL, Flournoy N, Thomas ED, et al. Antileukemic effect of graft-versus-host disease in human recipients of allogeneic-marrow grafts. N Engl J Med. 1979;300: 1068\u0026ndash;73\u003c/li\u003e\n\u003cli\u003eBerger M, Figari O, Bruno B, et al. Lymphocyte subsets recovery following allogeneicbone marrow transplantation (BMT):CD4\u0026thorn; cell count and transplant-related mortality. Bone Marrow Transplant. 2008; 41:55 62.\u003c/li\u003e\n\u003cli\u003eHorowitz MM, Gale RP, Sondel PM, Goldman JM, Kersey J, Kolb HJ et al. Graft-versus-leukemia reactions after bone marrow transplantation.Blood 1990; 75: 555\u0026ndash;562.\u003c/li\u003e\n\u003cli\u003eFowler DH. Shared biology of GVHD and GVT effects: potential methods of separation. Crit Rev Oncol Hematol 2006; 57:225-44.\u003c/li\u003e\n\u003cli\u003eB\u0026uuml;hlmann L, Buser AS, Cantoni N, et al. Lymphocyte subset recovery and outcome after T-cell replete allogeneic hematopoietic SCT. Bone Marrow Transplant 2011;46:1357-62.\u003c/li\u003e\n\u003cli\u003eChakrabarti S, Brown J, Guttridge M, et al. Early lymphocyte recovery is important determinant of outcome following allogeneic transplantation with CD34\u0026thorn; selected graft and limited T-cell addback. Bone Marrow Transplant 2003; 32:23e-30.\u003c/li\u003e\n\u003cli\u003eFallen PR, McGreavey L, Madrigal JA, et al. Factors affecting reconstitution of the T cell compartment in allogeneic haematopoietic cell transplant recipients. Bone Marrow Transplant. 2003; 32:1001-1014.\u003c/li\u003e\n\u003cli\u003eHeining C, Spyridonidis A, Bernhardt E, et al. Lymphocyte reconstitution following allogeneic hematopoietic stem cell transplantation: a retrospective study including 148 patients. Bone Marrow Transplant. 2007; 39:613-622\u003c/li\u003e\n\u003cli\u003eValc\u0026aacute;rcel, D., Sureda, A. (2019). Graft Failure. In: Carreras, E., Dufour, C., Mohty, M., Kr\u0026ouml;ger, N. (eds) The EBMT Handbook. Springer, Cham.\u003c/li\u003e\n\u003cli\u003eAzam F, Latif MF, Farooq A, Tirmazy SH, AlShahrani S, Bashir S, Bukhari N. Performance Status Assessment by Using ECOG (Eastern Cooperative Oncology Group) Score for Cancer Patients by Oncology Healthcare Professionals. Case Rep Oncol. 2019 Sep 25;12(3):728-736\u003c/li\u003e\n\u003cli\u003eSorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, Storer B. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005 Oct 15;106(8):2912-9.\u003c/li\u003e\n\u003cli\u003eArmand P, Kim HT, Logan BR et al. Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation. Blood. 2014 Jun 5;123(23):3664-71\u003c/li\u003e\n\u003cli\u003eLe Blanc K, Barrett AJ, Schaffer M et al. Lymphocyte recovery is a major determinant of outcome after matched unrelated myeloablative transplantation for myelogenous malignancies. Biol Blood Marrow Transplant. 2009 Sep;15(9):1108-15.\u003c/li\u003e\n\u003cli\u003eMichelis FV, Messner HA, Loach D, et al. Early lymphocyte recovery at 28 d post-transplant is predictive of reduced risk of relapse in patientswith acute myeloid leukemia transplanted with peripheral blood stem cell grafts. Eur J Haematol. 2014;93:273-280.\u003c/li\u003e\n\u003cli\u003eKumar S, Chen MG, Gastineau DA, et al. Lymphocyte recovery after allogeneic bone marrow transplantation predicts risk of relapse in acute lymphoblastic leukemia. Leukemia 2003;17:1865e70\u003c/li\u003e\n\u003cli\u003eAmandine Le Bourgeois, Pierre Peterlin, Thierry Guillaume et al.Early Monocyte and Total Lymphocyte Counts Are Associated with Better Overall Survival after Standard Total Body Irradiation, Cyclophosphamide, and Fludarabine Reduced-Intensity Conditioning Double Umbilical Cord Blood Allogeneic StemCell Transplantation in Adults, Biology of Blood and Marrow Transplantation,Volume 22, Issue 8, 2016, Pages 1473-1479, ISSN 1083- 8791.\u003c/li\u003e\n\u003cli\u003eRigoni L, Scroferneker ML, Pitombeira BS, Ottoni E, Paz A, Fischer G, Michalowski M, Pezzi A, Amorin B, Valim V, Baggio L, Laureano \u0026Aacute;, da Silva MA, Silla L, Daudt L. Importance of early absolute lymphocyte count after allogeneic stem cell transplantation: a retrospective study. Transplant Proc. 2015 Mar;47(2):511-6. doi: 10.1016/j.transproceed.2014.11.042. PMID: 25769599. 3e2223.\u003c/li\u003e\n\u003cli\u003eKim HT, Armand P, Frederick D, Andler E, Cutler C, Koreth J, Alyea EP 3rd, Antin JH, Soiffer RJ, Ritz J, Ho VT. Absolute lymphocyte count recovery after allogeneic hematopoietic stem cell transplantation predicts clinical outcome. Biol Blood Marrow Transplant. 2015 May;21(5):873-80. doi: 10.1016/j.bbmt.2015.01.019. Epub 2015 Jan 23. PMID: 25623931.\u003c/li\u003e\n\u003cli\u003eDe Koning J, Van Bekkum DW et al. Transplantation of bone-marrow cells and fetal thymus in an infant with lymphopenic immunological deficiency. Lancet 1969; 1:1223\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eHenig I, Zuckerman T. Hematopoietic stem cell transplantation-50 years of evolution and future perspectives. Rambam Maimonides Med J. 2014 Oct 29;5(4):e0028. doi: 10.5041/RMMJ.10162. PMID: 25386344; PMCID: PMC4222417.\u003c/li\u003e\n\u003cli\u003eKollman C, Spellman SR, Zhang MJ, et al. The effect of donor characteristics on survival after unrelated donor transplantation for hematologic malignancy. Blood. 2016;127:260\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eDe Koning J, Van Bekkum DW et al. Transplantation of bone-marrow cells and fetal thymus in an infant with lymphopenic immunological deficiency. Lancet 1969; 1:1223\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eDamlaj M, Ghazi S, Mashaqbeh W, Gmati G et al. Lymphocyte recovery is an independent predictor of relapse in allogeneic hematopoietic cell transplantation recipients for acute leukemia. World J Transplant. 2017 Aug 24;7(4):235-242. doi: 10.5500/wjt.v7.i4.235. PMID: 28900606; PMCID: PMC5573899.\u003c/li\u003e\n\u003cli\u003eYanagi, M., Kobayashi, R., Matsushima, S., Hori, D., Kodama, K., Suzuki, D. and Kobayashi, K. (2022), Early reconstitution of lymphocytes after allogenic hematopoietic stem cell transplantation affects chronic graft-versus-host disease. Pediatrics International, 64: e15222. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4874233/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4874233/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAllogeneic hematopoietic stem cell transplantation (AlloHSCT) is a therapeutic method for the treatment of many malignant and non-malignant hematological diseases but is still associated with significant morbidity and mortality. Disease relapse recurrence and non-relapse mortality (NRM) remain the main causes of failure from AlloHSCT. The \u0026nbsp;\u0026nbsp;identification of the risk factors associated with this continue to be a subject of extensive scientific research. The aim of our study was to identify the prognostic significance of the early lymphocyte recovery (ELR), presented as absolute lymphocyte count (ALC) for the outcome of AlloHSCT.\u003c/p\u003e","manuscriptTitle":"Early Lymphocytic Recovery After Allogeneic Transplation of Hemopoetic Stem Cells in Patients with Hematologic Malignancies – Single Center Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-08 00:41:49","doi":"10.21203/rs.3.rs-4874233/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dfaf09c0-4feb-4bd1-beb2-68ddf5e9126c","owner":[],"postedDate":"October 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-27T13:08:38+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-08 00:41:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4874233","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4874233","identity":"rs-4874233","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}