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Biol Blood Marrow Transplant. 2015 Jul;21(7):1284-90. doi: 10.1016/j.bbmt.2015.02.017. Epub 2015 Feb 20.

General and Virus-Specific Immune Cell Reconstitution after Double Cord Blood Transplantation.

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Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas.
Department of Pediatrics, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
Department of Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas.
Department of Infectious Diseases, MD Anderson Cancer Center, Houston, Texas.
Hematology/Oncology and Bone Marrow Transplant, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California San Diego, La Jolla, California.
Division of Blood and Marrow Transplantation, Children's National Hospital System and George Washington University, Washington, DC.
Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas. Electronic address:


Cord blood transplantation (CBT) is curative for many patients with hematologic malignancies but is associated with delayed immune recovery and an increased risk of viral infections compared with HLA-matched bone marrow or peripheral blood progenitor cell transplantation. In this study we evaluated the significance of lymphocyte recovery in 125 consecutive patients with hematologic malignancies who underwent double-unit CBT (DUCBT) with an antithymocyte globulin-containing regimen at our institution. A subset of 65 patients was prospectively evaluated for recovery of T, natural killer (NK), and B cells, and in 46 patients we also examined viral-specific T cell recovery against adenovirus, Epstein-Barr virus, cytomegalovirus, BK virus, respiratory syncytial virus, and influenza antigen. Our results indicate that in recipients of DUCBT, the day 30 absolute lymphocyte count is highly predictive of nonrelapse mortality and overall survival. Immune recovery post-DUCBT was characterized by prolonged CD8+ and CD4+ T lymphopenia associated with preferential expansion of B and NK cells. We also observed profound delays in quantitative and functional recovery of viral-specific CD4+ and CD8+ T cell responses for the first year post-CBT. Taken together, our data support efforts aimed at optimizing viral-specific T cell recovery to improve outcomes post-CBT.


Absolute lymphocyte count; B cells; NK cells; Post-transplant; Post-transplant infections; T cells

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