To compare post-HSCT immune reconstitution and clinical outcomes in children with relapsed or refractory B-ALL who received pre-HSCT immunotherapy versus chemotherapy alone.
Approach:
Design and population: Retrospective review of children with B-ALL who underwent HSCT at Peking University People’s Hospital from January 2020 through December 2024. The overall first-HSCT cohort included 312 patients: 144 received chemotherapy alone and 168 received pre-HSCT immunotherapy. The immune-reconstitution comparison included 305 patients: 142 in the chemotherapy group and 163 in the immunotherapy group.
Assessment: Lymphocyte subsets and immunoglobulins were assessed at 1, 2, 6, 12, and 24 months after HSCT. Group patterns over time were analyzed using generalized additive mixed models (GAMM).
Key Findings:
Immune recovery was progressive but incomplete. At 24 months, age-adjusted Z-scores remained below expected values for total T cells and CD4+ T cells; CD8+ T-cell recovery was faster, while the CD4/CD8 ratio remained low.
B-cell counts remained low through month 6 and then increased. IgM and IgA rose over time, while IgG declined through month 6 and partially recovered by month 24.
GAMM analyses found group effects for several T-cell subsets. Post-hoc comparisons reported higher CD4+CD45RO+ T-cell levels in the chemotherapy group across follow-up, and higher CD4+CD28+ and CD8+CD28+ levels at selected time points. Recovery trajectories differed between groups for some subsets.
B-cell counts and IgG and IgM concentrations had similar trajectories between groups. IgA trajectories differed, with higher values in the chemotherapy group early after HSCT and higher values in the immunotherapy group at month 24.
Interpretation:
The reported analyses found differences between pre-HSCT treatment groups in the levels or recovery trajectories of several T-cell subsets. The supplied context does not include clinical-outcome comparisons or the complete study conclusion.
Limitations:
The study was retrospective and conducted at a single center.
The supplied context does not include clinical-outcome comparisons or the complete article conclusion.
The overall HSCT cohort included 312 patients, while the immune-reconstitution comparison included 305; the supplied context does not explain the difference.
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