Rapid lymphocyte recovery after bone marrow or peripheral blood transplantation is associated with improved survival. However, the impact of early lymphocyte recovery has not been examined after umbilical cord blood transplant (UCBT). We evaluated lymphocyte recovery in 360 consecutive patients with hematologic malignancy that underwent UCBT between 2001 and 2007. Uniform myeloablative (MA), reduced intensity conditioning (RIC) and graft vs. host disease prophylaxis regimens were used. In multivariate analysis, an ALC >200 ×106/L at day 30 (n=73) after MA conditioning was associated with superior 2-year overall survival (OS) (73% vs. 61%; p=0.02) [RR: 2.29; 95% CI: 1.15 – 4.56], progression-free survival (PFS) (68% vs. 54%; p=0.05) [RR: 1.96; 95% CI: 0.99 – 3.86] and less transplant related mortality (TRM) (8% vs. 28%, p<0.01) [RR: 4.38; 95% CI: 1.65 – 11.60] compared to ≤200×106/L (n=43). Similarly, an ALC >200 ×106/L at day 42 (n=105) after RIC was associated with superior 2-year OS (59% vs. 41%, p<0.01) [RR: 2.10; 95% CI: 1.3 – 3.41] and PFS (46% vs. 36%, p=0.05) [RR: 1.58; 95% CI: 1.01 – 2.49] compared to ≤200 ×106/L (n=55). There was no significant relationship between ALC and relapse. Rapid lymphocyte recovery early after UCBT predicts better survival in patients with hematologic malignancies.

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Fanconi Anemia (FA) is an inherited disorder that arises due to defects in DNA repair pathways and predisposes affected individuals to bone marrow failure and malignancy. The hematologic aberrations of FA can be cured through hematopoietic cell transplantation (HCT); however, HCT carries with it the risk of post-transplant lymphoproliferative disorder (PTLD). PTLD that progresses to lymphoma is difficult to treat in patients with FA due to their increased susceptibility to toxicities from traditional cytotoxic alkylating chemotherapy. This case reports the outcome of a 6-year-old male with FA who underwent mismatched unrelated donor HCT and subsequently developed monomorphic Epstein Barr Virus (EBV)-driven PTLD. His disease progressed through reduction of immunosuppression, rituximab, and viral-specific third-party cytotoxic T-cells, but had a complete response to a 28day infusion of blinatumomab. The patient is now 1-year post-HCT and over 7 months postblinatumomab infusion with ongoing sustained complete response. This case reinforces management challenges in the treatment of PTLD in patients with FA, reports the novel use of blinatumomab for the successful treatment of PTLD, and highlights the role for targeted immunotherapies in unique patient populations who may be unable to tolerate the effects of traditional chemotherapy.