Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy with poor prognosis. Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative treatment. Immune reconstitution (IR) is critical for improving HSCT efficacy and quality of life among survivors, yet its dynamic impact on survival and complications like chronic graft-versus-host disease (cGVHD) in CMML is poorly defined. This study aimed to investigate the dynamics of IR following HSCT in patients with CMML and evaluate its impact on post-transplant clinical outcomes.
Chronic myelomonocytic leukemia (CMML) is a myeloid malignancy exhibiting clinical and morphological features of both myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPNs). The optimal treatment regimen remains unclear, and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently the only known potentially curative treatment option. During allo-HSCT, the recipient's immune system undergoes reconstitution from donor-derived cells. Timely engraftment and functional recovery of the donor immune system are critical for patient recovery and long-term survival post-transplantation. While HSCT can achieve durable remission, it is associated with significant life-threatening complications, primarily mediated by rapidly reconstituted immune components. However, the cellular dynamics underlying the re-establishment of immune homeostasis between donor and recipient compartments post-HSCT remain poorly characterized. This study aims to delineate the kinetics of immune reconstitution (IR) in CMML patients following allo-HSCT, dynamically analyze its impact on clinical outcomes and prognosis, and ultimately develop and optimize immunotherapeutic strategies to enhance overall survival and improve quality of life.
Study Type
OBSERVATIONAL
Enrollment
300
Detection of immune reconstitution in peripheral blood of patients by flow cytometry at 30-day intervals for 180 days post-transplantation.
Immune reconstitution
To quantify the percentages（%） of lymphocyte subsets (including CD19+ B cells, CD3+ T cells, CD4+ T cells, CD8+ T cells, CD3+CD8+CD28+ T cells, CD3+CD4+CD28+ T cells, CD4+CD45RA+ naive T cells, CD4+CD45RO+ memory T cells, CD4+CD25+CD45RA+ naive regulatory T cells, CD4+CD25+CD45RO+ memory regulatory T cells, and CD4+CD25+ total regulatory T cells) relative to nucleated cells using flow cytometry.
Time frame: 180 days
Immunoglobulin levels
To test for serum immunoglobulin (IgG, IgA, IgM) (mg/dL).
Time frame: 180 days
2-year OS
To describe the incidence of 2-year OS
Time frame: 2 years
5-year PFS
To describe the incidence of 5-year PFS
Time frame: 5 years
cGVHD
To describe the number of patients diagnosed with chronic graft-versus-host disease (cGVHD)
Time frame: 5 years
Bacterial infection
To describe the number of patients with bacterial infection detected in blood, stool, sputum, etc. after HSCT
Time frame: 5 years
Fungal infection
To describe the number of patients with fungal infection detected in blood, stool, sputum, etc. after HSCT
Time frame: 5 years
Viral infection
To describe the number of patients with viral infection detected in blood, stool, sputum, etc. after HSCT
Time frame: 5 years
aGVHD
To describe the number of patients diagnosed with acute graft-versus-host disease (aGVHD)
Time frame: 100 days
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