Can immune reconstitution parameters be highlighted for chronic graft versus host disease in children one month after HSCT?

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Introduction: Haematopoietic stem cell transplantation (HSCT) is a critical treatment for various diseases, with immune system reconstitution being vital for its success. The risk of complications, including graft-versus-host disease (GVHD), is associated with delayed immune reconstitution. Chronic GVHD (cGVHD) remains a long-term complication affecting the quality of life and mortality post-HSCT. Predicting and managing cGVHD is challenging, emphasizing the need for early identification. Methods: A retrospective analysis of 81 pediatric HSCT patients aimed to predict cGVHD using immune parameters one month post-transplant. Lymphocyte subgroups, chimerism levels, and clinical factors were assessed. Statistical analyses included T tests, Chi-square, and regression analysis. Results: Patients with cGVHD showed significant associations with busulfan-containing regimens, ATG use, earlier neutrophil engraftment, acute GVHD history, and increased febrile days. Donor chimerism was higher in cGVHD. Analysis of immune parameters revealed elevated CD3+, CD4/8 ratio, CD4+25+ and CD8+57+ activated T lymphocytes at +1mo in cGVHD patients. CD8+ counts were lower in cGVHD. CD19+ B lymphocytes were lower at +3, +6, and +12mo in cGVHD. CD3/HLA-DR (+) activated T lymphocytes were higher in cGVHD, indicating T cell activation. Conclusion: The study suggests that certain immune parameters, particularly lymphocyte subgroups at post-transplant +1mo, may serve as predictive markers for cGVHD. Notably, higher CD3 (+) lymphocytes, CD4/25 (+), CD4/28 (+), CD8/57 (+), CD3/DR (+) activated T lymphocytes at +1mo may indicate their involvement in cGVHD pathogenesis. This study identifies specific immune parameters at post-transplant +1mo as potential predictive markers for cGVHD, aiding in risk assessment and personalized interventions for pediatric HSCT patients.