General and Virus-Specific Immune Cell Reconstitution after Double Cord Blood Transplantation

Biol Blood Marrow Transplant. 2015 Jul;21(7):1284-90. doi: 10.1016/j.bbmt.2015.02.017. Epub 2015 Feb 20.


Cord blood transplantation (CBT) is curative for many patients with hematologic malignancies but is associated with delayed immune recovery and an increased risk of viral infections compared with HLA-matched bone marrow or peripheral blood progenitor cell transplantation. In this study we evaluated the significance of lymphocyte recovery in 125 consecutive patients with hematologic malignancies who underwent double-unit CBT (DUCBT) with an antithymocyte globulin-containing regimen at our institution. A subset of 65 patients was prospectively evaluated for recovery of T, natural killer (NK), and B cells, and in 46 patients we also examined viral-specific T cell recovery against adenovirus, Epstein-Barr virus, cytomegalovirus, BK virus, respiratory syncytial virus, and influenza antigen. Our results indicate that in recipients of DUCBT, the day 30 absolute lymphocyte count is highly predictive of nonrelapse mortality and overall survival. Immune recovery post-DUCBT was characterized by prolonged CD8+ and CD4+ T lymphopenia associated with preferential expansion of B and NK cells. We also observed profound delays in quantitative and functional recovery of viral-specific CD4+ and CD8+ T cell responses for the first year post-CBT. Taken together, our data support efforts aimed at optimizing viral-specific T cell recovery to improve outcomes post-CBT.

Keywords: Absolute lymphocyte count; B cells; NK cells; Post-transplant; Post-transplant infections; T cells.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antigens, Viral / immunology
  • Antilymphocyte Serum / therapeutic use*
  • B-Lymphocytes / immunology
  • B-Lymphocytes / pathology
  • B-Lymphocytes / virology
  • Cord Blood Stem Cell Transplantation / adverse effects
  • Cord Blood Stem Cell Transplantation / methods*
  • Female
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / mortality
  • Hematologic Neoplasms / pathology
  • Hematologic Neoplasms / therapy*
  • Humans
  • Killer Cells, Natural / immunology
  • Killer Cells, Natural / pathology
  • Killer Cells, Natural / virology
  • Male
  • Middle Aged
  • Myeloablative Agonists / therapeutic use*
  • Prospective Studies
  • Risk
  • Survival Analysis
  • T-Lymphocytes / immunology
  • T-Lymphocytes / pathology
  • T-Lymphocytes / virology
  • Transplantation Conditioning*
  • Treatment Outcome
  • Virus Diseases / etiology
  • Virus Diseases / immunology*
  • Virus Diseases / mortality
  • Virus Diseases / virology


  • Antigens, Viral
  • Antilymphocyte Serum
  • Myeloablative Agonists