CD4−CD8−T Cell Reconstitution Combined with Acute GVHD and CMV Infection: A Robust Predictor of Overall Survival and Non-Relapse Mortality After HSCT

Immune reconstitution (IR), acute graft-versus-host disease (aGVHD), and cytomegalovirus (CMV) infection are all crucial factors influencing the prognosis following hematopoietic stem cell transplantation (HSCT).
A cohort of 116 pediatric patients undergoing HSCT was divided into two groups: those with aGVHD+CMV+ (DP group) and those without this combination (NDP group). Kaplan-Meier (KM) curves were generated to compare survival differences between the groups. Logistic regression analysis was performed to identify associations between IR and aGVHD+CMV+. Cox proportional hazards regression analysis was conducted to determine the independent risk factors affecting prognosis.
The prognosis of DP group was significantly worse than that of the NDP group. Notable disparities in lymphocyte subset levels were observed between the DP and NDP groups. The level of CD4−CD8−T cells showed a significant correlation with the co-occurrence of aGVHD and CMV infection. Impaired reconstitution of CD4−CD8−T cells and aGVHD+CMV+ were found to be independent risk factors for post-HSCT survival. Patients in DP group with CD4−CD8−T cell counts > 49 cells/µl (at day 90 post-HSCT) demonstrated a significantly improved prognosis.
Elevated CD4−CD8−T cell counts may mitigate the adverse effects of aGVHD and CMV infection on HSCT outcomes, suggesting their potential as a prognostic biomarker.