A Potent Thymic Function Is Associated with a Low Risk of Relapse In Leukemia Patients Treated with Haploidentical Stem Cell Transplantation
Authors: Clave Emmanuel , Lisini Daniela , Douay Corinne , Giorgiani Giovanna , Busson Marc , Zecca Marco , Charron Dominique , Bernardo Maria E. , Toubert Antoine , Locatelli Franco 
Published: October 2019

Abstract
Abstract 1258
Hematopoietic Stem Cell Transplantation (HSCT) is an effective treatment for many malignant and non malignant diseases in children. Since less than 30% of the patients have an HLA identical related donor, alternative donor/sources of Hematopoietic Stem Cells need to be considered, such as unrelated bone marrow (BM) and Cord Blood (CB) donors or HLA-haploidentical related donors. However, these types of HSCT are associated with a significant delay in immune reconstitution that favors both a high incidence of opportunistic infection and, in the absence of an alloreactive, natural killer cell-mediated effect, disease relapse. Indeed, T-cell depletion of the allograft in the haploidentical setting or T-cell naivety in CB, as well as HLA-disparity and use of serotherapy before HSCT, contribute to this impaired immune reconstitution. In view of the role played by the thymus in immune reconstitution post-allogeneic HSCT, it would be informative to compare thymic-dependent immune reconstitution after these types of HSCT.
We have studied immune reconstitution and thymic function through signal joint (sj) and beta T cell Receptor Excision Circles (TREC) quantification in a group of 33 haplo-HSCT pediatric patients and in a group of 24 unrelated CB-HSCT. Patients were transplanted mainly for hematological malignancies (n=46, including 31 Acute Lymphocytic Leukemia and 9 Acute Myeloid Leukemia). All children received a myeloablative conditioning regimen, including the combination of total body irradiation and chemotherapy (n=33) or chemotherapy alone (n=24). In haplo-HSCT, no pharmacological immune-suppression was given after the allograft, while patients given CB-HSCT received cyclosporine-A and steroids as Graft vs. Host Disease (GvHD) prophylaxis. In haplo-HSCT patients the median number of CD34+ cells infused/kg was 20.7 × 106 (range 8.7–41), while in patients given CB-HSCT the median number of nucleated cells infused/kg was 7.1) × 107 (range 1.4–12.5). The only significant difference between the 2 groups was that haplo-HSCT patients were older (p=.0008) than CB-HSCT patients (median age being 7.7 and 3.4 yrs, range 3–17 and 0.75–16 yrs, respectively). Patients treated for an hematological malignancy had a significant lower pre-transplant TREC value (p = .0002 and .004 for sj and beta TREC respectively) than those affected by non-malignant diseases in both groups. Number of sj and betaTREC per 150 000 PBMC or absolute counts per μl of blood, showed a very similar thymic function in both groups despite the older age of haplo-HSCT patients. TREC levels were comparable to those found before transplantation starting from 6 months after HSCT. Cumulative incidence of acute or chronic GvHD was low in both groups, with no significant impact on thymic function.
In haplo-HSCT, but not in CB transplantation, patients treated for hematological malignancies (n=27) who relapsed (n=8) had a significantly lower level of thymic function (sjTREC) than those who did not relapse (n=19), before (p=0.03), after 3 (p=0.014) and 6 months (p=0.015) from the allograft. In this group of patients, relapse was not associated with age, conditioning regimen or number of CD34+ cells infused. In conclusion, we demonstrate the crucial importance of thymic function in the Graft-vs. Leukemia effect in the haplo-HSCT setting. Monitoring thymic function could be of predictive value in these patients.

Disclosures:
No relevant conflicts of interest to declare.