Clinical Analysis Of Early Immune Reconstruction And AGVHD Occurrence After RIC-RH-PBSCT

Objective: To analyze the early immune reconstruction and the occurrence of aGVHD after the reduced-intensity conditioning related HLA-haploidentical peripheral hematopoietic stem cell transplantation.Methods: A total of 25 patients undergoing RIC-RH-PBSCT in our center from January 2013 to July 2018 enrolled in this study.Transplanted with high dose peripheral hematopoietic stem cell.The dynamic characteristics of each immune cell subgroup and the occurrence of aGVHD in the early stage after transplantation were analyzed.Results:(1)All the 25 patients obtained hematopoietic reconstruction within 1 month after transplantation.The mean time of granulocyte implantation was 18 days(12-30 days).The mean time of platelet implantation was 18 days(11-39 days).(2)In this mode,total CD3+ T decreased within 30 days after transplantation and reached normal control level at 60 days after transplantation.CD4+T lymphocytes decreased at 30 days after transplantation,with a continuous low level and slow recovery.CD4+T lymphocytes were the slowest to recovered and did not return to normal level 90 days after transplantation.CD8+T lymphocytes decreased 30 days after transplantation,significantly increased 60 days after transplantation,and then decreased slowly.NK cells was peaked 30 days after transplantation and then decreased to the normal control level.B lymphocytes remained low for 60 days after transplantation and returned to normal at 90 days after transplantation.IgG increased significantly 30 days after transplantation,and then decreased gradually.The level of IgA and IgM after transplantation was lower than that of normal control.(3)The cumulative incidence of aGVHD was 52%,I-Ⅱ aGVHD incidence was 46.57%,Ⅲ-Ⅳ aGVHD incidence was10.16%.There were 9 cases of skin,1 case of intestinal tract,2 cases of liver and 1 case of oral cavity.(4)The number of CD8+T lymphocytes in the group with and without aGVHDwas significantly higher than in the group without aGVHD(35.62 25.5)% VS(14.412.6)%).(76.6 + /-20.9%)VS(58.2 + 24.2)%(P < 0.05).Conclusion: 1.In the early stage after our unique RIC-RH-PBSCT model,NK cells recovered the fastest,followed by CD3+T lymphocytes and CD8+T lymphocytes.CD4+T lymphocytes were the slowest to recovered and did not return to normal level 90 days after transplantation..B lymphocytes and humoral immunity recovered slowly.2.In this model,the incidence of severe aGVHD was not high,and the occurrence of CD8+T cells in T cell subsets was related to the occurrence of aGVHD after transplantation,which had statistical significance.Dynamic monitoring of lymphocyte subsets was helpful to predict the occurrence of aGVHD...