Comparing Immune Reconstitution Following Post-Transplant Cy Myeloablative vs. Reduced Intensity Transplants
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Abstract
The incidence of graft versus host disease (GVHD) following allogeneic hematopoietic stem cell transplantation (HSCT) remains a significant obstacle to successful outcomes. Although the efficacy of post-transplant cyclophosphamide (PTCy) as prophylaxis to GVHD has showed its ability to target and kill T cells that cause GVHD, PTCy myeloablative treatment has been linked to delayed T cell reconstitution. Reduced-intensity transplants can be utilized since it is associated with lower rates of acute and chronic GVHD, yet similar overall survival compared to Tac/MTX. Therefore, this proposed study aimed to investigate the effectiveness of PTCy reduced intensity (RIC) as prophylaxis for GVHD and compare the immune reconstitution ability with PTCy myeloablative intensity (MAC) and Tac/MTX control group. By utilizing the OMIP-042 protocol for staining antibodies in flow cytometry and FlowJo software for analysis, the results suggested that the monocyte populations were significantly affected after transplant. PTCy MAC patients (with GVHD) had significantly more monocytes compared to Tac/MTX MAC (no GVHD), while Tac/MTX RIC (no GVHD) patients had significantly more monocytes compared to PTCy RIC patients (either with GVHD or no GVHD). PTCy MAC patients (with GVHD) had increased monocyte populations compared to PTCy RIC patients (with GVHD), who also had increased monocyte populations compared to PTCy RIC (no GVHD) patients. There was no significant difference in immune reconstitution between GVHD vs. no GVHD patients. Further studies should be conducted to include patient samples on Day 90 and include more patient samples to detect the immune reconstitution trend. The results of this study could help understand the immune reconstitution in current prophylaxis for GVHD and improve patient outcomes associated with HSCT.