{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T14:56:10Z","timestamp":1771512970356,"version":"3.50.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Anti-thymocyte globulin (ATG) is frequently administered for preventing graft-versus-host disease (GVHD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). In patients with low absolute lymphocyte count (ALC) before conditioning, weight-based dosing of ATG may cause overexposure, negatively impacting prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Clinical data of patients with hematological malignancies undergoing haploidentical HSCT (haplo-HSCT) at the Children\u2019s Hospital of Soochow University from January 2020 to June 2023 were collected. This study primarily aims to investigate the association between pre-conditioning ALC and clinical outcomes in pediatric acute leukemia or myelodysplastic syndromes patients receiving myeloablative haplo-HSCT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 130 patients treated at the Children\u2019s Hospital of Soochow University from January 2020 to June 2023. According to the cutoff of 500\/\u03bcl, patients were divided into high and low ALC groups. Patients in the high ALC group experienced a higher incidence of II-IV acute GVHD (30.2% versus 13.6%, <jats:italic>P<\/jats:italic> = 0.034), 3-year overall survival (OS) and relapse-free survival (RFS) rates (OS: 88.5% \u00b1 3.7% versus 66.9% \u00b1 7.9%, <jats:italic>P<\/jats:italic> = 0.013; RFS: 81.4% \u00b1 4.1% versus 56.5% \u00b1 8.1%, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), and lower cumulative incidence of relapse (11.3% versus 27.4%, <jats:italic>P<\/jats:italic> = 0.013). Pre-conditioning ALC &amp;lt; 500\/\u03bcl independently predicted worse OS, RFS, and higher relapse risk in multivariate analysis. However, there was no significant difference in immune reconstitution between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pre-conditioning ALC was a significant prognostic factor in pediatric patients undergoing myeloablative haplo-HSCT. Further research is needed to explore whether pre-conditioning ALC can serve as a reference for adjusting ATG dosing.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1552263","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T01:23:24Z","timestamp":1742952204000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Lower pre-conditioning absolute lymphocyte counts are associated with worse outcomes in haploidentical stem cell transplantation with myeloablative regimen in children"],"prefix":"10.3389","volume":"16","author":[{"given":"Kai","family":"Cui","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Senlin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yueke","family":"Du","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutan","family":"Chai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingchu","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaoyan","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2015.306","article-title":"Causes of mortality after haploidentical hematopoietic stem cell transplantation and the comparison with HLA-identical sibling hematopoietic stem cell transplantation","volume":"51","author":"Yan","year":"2016","journal-title":"Bone Marrow Transplantation"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14965","article-title":"Outcome of relapse after allogeneic HSCT in children with ALL enrolled in the ALL-SCT 2003\/2007 trial","volume":"180","author":"Kuhlen","year":"2018","journal-title":"Br J Haematology"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3390\/cells13181524","article-title":"Current approaches for the prevention and treatment of acute and chronic GVHD","volume":"13","author":"Olivieri","year":"2024","journal-title":"Cells"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2014.11.676","article-title":"Rabbit anti-T cell globulin in allogeneic hematopoietic cell transplantation","volume":"21","author":"Storek","year":"2015","journal-title":"Biol Blood Marrow Transplantation: J Am Soc For Blood Marrow Transplantation"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.717678","article-title":"Anti-thymocyte globulin prophylaxis in patients with hematological Malignancies undergoing allogeneic hematopoietic stem cell transplantation: an updated meta-analysis","volume":"11","author":"Yang","year":"2021","journal-title":"Front In Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(15)00045-9","article-title":"Association between anti-thymocyte globulin exposure and CD4+ immune reconstitution in paediatric haemopoietic cell transplantation: a multicentre, retrospective pharmacodynamic cohort analysis","volume":"2","author":"Admiraal","year":"2015","journal-title":"Lancet Haematology"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-06-721936","article-title":"Excellent T-cell reconstitution and survival depend on low ATG exposure after pediatric cord blood transplantation","volume":"128","author":"Admiraal","year":"2016","journal-title":"Blood"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-019-0643-9","article-title":"Personalizing rabbit anti-thymocyte globulin therapy for prevention of graft-versus-host disease after allogeneic hematopoietic cell transplantation: is there an optimal dose","volume":"55","author":"Shichijo","year":"2020","journal-title":"Bone Marrow Transplant"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(17)30029-7","article-title":"Association between anti-thymocyte globulin exposure and survival outcomes in adult unrelated haemopoietic cell transplantation: a multicentre, retrospective, pharmacodynamic cohort analysis","volume":"4","author":"Admiraal","year":"2017","journal-title":"Lancet Haematology"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2020.06.005","article-title":"Preconditioning absolute lymphocyte count and transplantation outcomes in matched related donor allogeneic hematopoietic stem cell transplantation recipients with reduced-intensity conditioning and antithymocyte globulin treatment","volume":"26","author":"Woo","year":"2020","journal-title":"Biol Blood Marrow Transplantation: J Am Soc For Blood Marrow Transplantation"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2015.09.001","article-title":"International, multicenter standardization of acute graft-versus-host disease clinical data collection: A report from the mount sinai acute GVHD international consortium","volume":"22","author":"Harris","year":"2016","journal-title":"Biol Blood Marrow Transplantation: J Am Soc For Blood Marrow Transplant"},{"key":"B12","doi-asserted-by":"publisher","first-page":"20406207211063783","DOI":"10.1177\/20406207211063783","article-title":"Association between preconditioning absolute lymphocyte count and transplant outcomes in patients undergoing matched unrelated donor allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning and anti-thymocyte globulin","volume":"12","author":"Seo","year":"2021","journal-title":"Ther Adv In Hematology"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2020.1805114","article-title":"Absolute lymphocyte count on the first day of thymoglobulin predicts relapse-free survival in matched unrelated peripheral blood stem cell transplantation","volume":"61","author":"Modi","year":"2020","journal-title":"Leukemia Lymphoma"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2015.0151","article-title":"Survival in patients with severe lymphopenia following treatment with radiation and chemotherapy for newly diagnosed solid tumors","volume":"13","author":"Grossman","year":"2015","journal-title":"J Natl Compr Canc Netw"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2017.08.029","article-title":"Optimizing antithymocyte globulin dosing for unrelated donor allogeneic hematopoietic cell transplantation based on recipient absolute lymphocyte count","volume":"24","author":"Kennedy","year":"2018","journal-title":"Biol Blood Marrow Transplantation: J Am Soc For Blood Marrow Transplantation"},{"key":"B16","doi-asserted-by":"publisher","first-page":"9636897221079739","DOI":"10.1177\/09636897221079739","article-title":"Lower absolute lymphocyte count before conditioning predicts high relapse risk in patients after haploidentical peripheral blood stem cell transplantation with low dose anti-thymocyte globulin\/post-transplant cyclophosphamide for gvHD prophylaxis","volume":"31","author":"Zhou","year":"2022","journal-title":"Cell Transplantation"},{"key":"B17","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1186\/s12967-015-0748-x","article-title":"Differential impact of two doses of antithymocyte globulin conditioning on lymphocyte recovery upon haploidentical hematopoietic stem cell transplantation","volume":"13","author":"Liu","year":"2015","journal-title":"J Trans Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2002.03495.x","article-title":"Evidence that continued remission in patients treated for acute leukaemia is dependent upon autologous natural killer cells","volume":"117","author":"Lowdell","year":"2002","journal-title":"Br J Haematology"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-04-277939","article-title":"Early lymphocyte recovery after intensive timed sequential chemotherapy for acute myelogenous leukemia: peripheral oligoclonal expansion of regulatory T cells","volume":"117","author":"Kanakry","year":"2011","journal-title":"Blood"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2400891","article-title":"Reconstitution of peripheral blood lymphocyte subsets in the long-term disease-free survivors of patients with acute myeloblastic leukemia","volume":"12","author":"Ohnishi","year":"1998","journal-title":"Leukemia"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmii.2024.02.005","article-title":"Ten-year epidemiology and risk factors of cytomegalovirus infection in hematopoietic stem cell transplantation patients in Taiwan","volume":"57","author":"Huang","year":"2024","journal-title":"J Microbiology Immunology Infection = Wei Mian Yu Gan Ran Za Zhi"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3390\/v16081294","article-title":"EBV reactivation and disease in allogeneic hematopoietic stem cell transplant (HSCT) recipients and its impact on HSCT outcomes","volume":"16","author":"Law","year":"2024","journal-title":"Viruses"},{"key":"B23","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/s12916-019-1393-7","article-title":"Two dose levels of rabbit antithymocyte globulin as graft-versus-host disease prophylaxis in haploidentical stem cell transplantation: a multicenter randomized study","volume":"17","author":"Lin","year":"2019","journal-title":"BMC Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.00782","article-title":"B cell reconstitution and influencing factors after hematopoietic stem cell transplantation in children","volume":"10","author":"van der Maas","year":"2019","journal-title":"Front In Immunol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.bbmt.2015.08.028","article-title":"Immune reconstitution after allogeneic hematopoietic cell transplantation in children","volume":"22","author":"de Koning","year":"2016","journal-title":"Biol Blood Marrow Transplantation: J Am Soc For Blood Marrow Transplantation"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26094","article-title":"Cytomegalovirus kinetics after hematopoietic cell transplantation reveal peak titers with differential impact on mortality, relapse and immune reconstitution","volume":"96","author":"Leserer","year":"2021","journal-title":"Am J Hematology"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-020-04347-1","article-title":"High lymphocyte counts before antithymocyte globulin administration predict acute graft-versus-host disease","volume":"100","author":"Shiratori","year":"2021","journal-title":"Ann Hematology"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1552263\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T01:23:26Z","timestamp":1742952206000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1552263\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":27,"alternative-id":["10.3389\/fimmu.2025.1552263"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1552263","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,25]]},"article-number":"1552263"}}