Observational studyFrontiers in immunology2026
Impact of post-transplant cyclophosphamide and anti-thymocyte globulin on immune reconstitution in MUD allo-HCT.
Observational study in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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16 authors.
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Abstract
Insufficient immune reconstitution (IR) is a major determinant of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). Strategies for graft-versus-host disease (GVHD)-prophylaxis, such as anti-thymocyte globulin (ATG) and post-transplant cyclophosphamide (PTCy), modulate immune recovery, but their effects on IR in matched unrelated donor (MUD) allo-HCT remain incompletely defined. In this retrospective bi-centric study, we analyzed patients with myeloid malignancies undergoing MUD allo-HCT who received ATG or PTCy per center policy. Longitudinal IR and clinical outcomes were assessed. IR was defined as sustained recovery of CD3+CD4+ cells >200/μl and CD19+ cells >50/μl. The impact of GVHD-prophylaxis (ATG vs PTCy) on IR dynamics was explored. A total of 252 patients were included. By day +365, 16.7% achieved IR, which was independently associated with superior OS (HR 0.39, 95% CI 0.17-0.90; p=0.026) and lower TRM (HR 0.08, 95% CI 0.01-0.63; p=0.017). In multivariable competing-risk analyses, younger donor age (sHR 0.97, 95% CI 0.94-1.00; p=0.037) and PTCy (sHR 0.49, 95% CI 0.27-0.84; p=0.01) were associated with higher probability of IR by month +18. The association between PTCy and IR was attenuated after adjusting for therapy-requiring acute or chronic GVHD, which independently delayed IR (HR 0.31, 95% CI 0.20-0.48; p<0.001). ATG and PTCy showed distinct IR trajectories: ATG associated with earlier NK expansion, PTCy led to enhanced adaptive T- and B-cell recovery from day +100. IR strongly predicted survival, independently of GVHD-prophylaxis. Prospective studies are warranted to better define determinants of IR after MUD allo-HCT in the PTCy era.
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