Expansion of Large Granular Lymphocytes Following Allogeneic Stem Cell Transplantation: Its Association with Graft-Versus-Host Disease and Graft-Versus-Leukemia Effect.
Bibliographic record
Abstract
Abstract Abstract 2253 Poster Board II-230 Background: Expansion of large granular lymphocytes (LGLs) following allogeneic hematopoietic stem cell transplantation (HSCT) has been reported infrequently, and data from large scaled population is still lacking. Expansion of LGLs following HSCT has been suggested to be associated either with the development of graft-versus-host disease (GVHD) associated with graft-versus-leukemia (GVL) effect or with viral infection such as CMV or VZV reactivation. Methods: A total of 500 consecutive patients who received HSCTs from related or unrelated donors between January 2000 and October 2007 at the Princess Margaret Hospital, Toronto, Canada were included in this retrospective study. LGL expansion has been defined as 1) increasing number of peripheral blood lymphocyte counts ≥ 3.0×109/L for at least 3 months, and 2) the predominance of LGLs in the peripheral blood smears. Cases with LGL expansion were investigated prospectively for immunophenotypic profiles and T-cell receptor RT-PCR for T-cell monoclonality. Results: Out of 500 recipients, 77 cases (15.4%) showed LGL expansion after HSCT. The median onset of LGL expansion was 312 days (95% C.I. 233-390 days). The 1-, 2- and 3-year(s) incidence of LGL expansion was 12.8±1.8%, 20.6±2.4%, and 25.7±2.9%, respectively. Compared to the patients without LGL expansion, improved transplant outcomes were observed in patients with LGL expansion: better overall survival (OS; 90% vs 46%, p<0.001), lower non-relapse mortality (NRM; 3% vs 38%, p<0.001), lower relapse incidence (10% vs 31%, p<0.001) and higher GVHD-specific survival (GSS; 97% vs 64%, p<0.001). Three risk factors were identified for the development of LGL expansion such as CMV serostatus of recipient, CMV reactivation, and occurrence of chronic GVHD. Higher incidence of LGL expansion was noted 1) in CMV seropositive recipients (CMV-R+) compared to CMV seronegative recipients (CMV-R-) regardless of CMV serostatus of the donor (p<0.001); 2) in patients experiencing CMV reactivation (p<0.001); 3) in patients developing chronic GVHD (p=0.007). Of interest, when dividing patients according to the recipient's CMV serostatus and the occurrence of chronic GVHD, the group with CMV-R+ and cGVHD+ showed the highest incidence of LGL expansion up to 46%, while those with CMV-R- and cGVHD+ showed intermediate risk of LGL expansion with 25% incidence, and those with CMV-R+/cGVHD- or with CMV-R-/cGVHD- showed only 3-6% incidence of LGL expansion. Conclusion: Expansion of LGLs following allogeneic HSCT is not uncommon, and strongly associates with favorable transplant outcomes including a lower relapse rate suggesting that LGLs may be involved in the mediation of a GVL effect. Disclosures: No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".