الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Introduction: Allo-HSCT is a potentially curative option for many patients with AML and ALL. NRM and relapse of the underlying disease are the main reasons of failure of Allo-HSCT. These complications are usually affected by the time of recovery of the immune system following Allo-HSCT. The aim of work: This study was designed to determine the optimum cutoff value of ALC, AMC and ANC recovery for outcome prediction after transplantation. We aimed also to determine factors affecting this recovery as well. Research Plan: We conducted this study of 100 adult Egyptian patients with acute leukemia who underwent Allo-HSCT. Our defined cutoff for recovery of ALC and AMC was 300/μL at day21 and for recovery of ANC was 500/μL at day21. The choice of cutoff of ALC and AMC recovery at 300/μL was based on the optimum prognostic cutoff value suggested by previous studies. The choice of the time point to assess recovery at day21 was based on the outcome prediction (the best predictor of OS was the recovery of ALC, AMC and ANC at day 21). Results: The recovery of ALC was associated with lower incidence of NRM. The recovery of AMC was associated with lower incidence of relapse. High ANC at day21 after transplantation was associated with lower incidence of NRM and better OS. The recovery of lymphocytes and monocytes were associated with lower risk of CMV reactivation. Fludarabine based conditioning; use of levofloxacin as a prophylactic antibiotic and use of vancomycin as a therapeutic antibiotic were significantly associated with less recovery of ALC and AMC at day21. HCV infection was significantly associated with less recovery of ANC and AMC at day21 When the multivariate analysis was implemented, early lymphocytes and monocytes recovery at our defined cutoff value (>300/µL at day21) were strong independent prognostic factors of favorable OS. Conclusion: Our findings suggest that ALC and AMC recovery according to our defined cutoff value have a significant prognostic impact on outcomes after Allo-HSCT. Finally, according to our data, we recommend the use of ALC and AMC at our defined cutoff value (300 cells/μL at day21 after transplant) as a useful, simple, practical and reliable tool to predict outcome after Allo-HSCT. Both are strong predictors of OS and DFS. Antibiotic policy and the type of conditioning regimen might impact ALC and AMC recovery; further studies are needed for better evaluation of factors implicating early ALC and AMC recovery post transplantation. Modifications of these factors may improve the outcome of Allo-HSCT.