{
  "abstract": "Introduction: Post-transplant cyclophosphamide (PTCy) is widely used for graft-versus-host disease (GvHD) prophylaxis in haploidentical hematopoietic cell transplantation. However, the kinetics of early immune reconstitution in real-world, heterogeneous cohorts, and their relationship with early outcomes, remain incompletely defined.\n\nMethods: In this prospective single-center study, 95 consecutive patients undergoing haploidentical transplantation with PTCy (October 2021 to December 2024) underwent serial multicolor flow cytometry before conditioning, at neutrophil engraftment, and on days +21, +28, +60 and +90. T, B and natural killer (NK) cells were enumerated, along with CD4+ and CD8+ naive, central memory, effector memory and terminal effector subsets. Regulatory T cells were assessed in 50 patients. An exploratory propensity-matched comparison was performed against a contemporaneous HLA-matched donor cohort.\n\nResults: Immune reconstitution followed a sequential pattern: NK cells recovered earliest (from day +21), B-cell recovery was delayed, and T cells expanded gradually, dominated by central and effector memory subsets, while naive and terminal effector subsets remained low through day +90. Grade II to IV acute GvHD occurred in 32.6% of patients, and transplant-related mortality (TRM) was 26.3% by day +100. No lymphocyte subset was significantly associated with acute GvHD, TRM or overall survival, and reconstitution kinetics were similar between myeloablative and reduced-intensity conditioning. In the propensity-matched comparison, day +100 TRM was higher in the haploidentical cohort, whereas acute GvHD and overall survival were comparable.\n\nDiscussion: Early immune reconstitution after haploidentical transplantation with PTCy proceeds in a characteristic sequence, but quantitative recovery of circulating lymphocyte subsets alone did not predict acute GvHD or early mortality. Larger studies incorporating functional immune assays and time-to-event modelling are needed to clarify these relationships.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hematology, Christian Medical College",
    "Department of Biotechnology-Regional Centre for Biotechnology (RCB)"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 18,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Nayanthara K. Bijukumar"
    },
    {
      "affs": [
        0
      ],
      "name": "Aswin Anand Pai"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Rachel Mariam Renji"
    },
    {
      "affs": [
        0
      ],
      "name": "Agila Jayaraman"
    },
    {
      "affs": [
        0
      ],
      "name": "Raveen Stephen Stallon Illangeswaran"
    },
    {
      "affs": [
        0
      ],
      "name": "Arun Kumar Arunachalam"
    },
    {
      "affs": [
        0
      ],
      "name": "Phaneendra D. V."
    },
    {
      "affs": [
        0
      ],
      "name": "Kavitha M. Lakshmi"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Eunice S. Edison"
    },
    {
      "affs": [
        0
      ],
      "name": "Sushil Selvarajan"
    },
    {
      "affs": [
        0
      ],
      "name": "Sharon Anbumalar Lionel"
    },
    {
      "affs": [
        0
      ],
      "name": "Anu Korula"
    },
    {
      "affs": [
        0
      ],
      "name": "Aby Abraham"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Vikram Mathews"
    },
    {
      "affs": [
        0
      ],
      "name": "Biju George"
    },
    {
      "affs": [
        0
      ],
      "name": "Sujith Karumathil"
    },
    {
      "affs": [
        0
      ],
      "name": "Uday Kulkarni"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Poonkuzhali Balasubramanian"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/f9w4vwvqzjqzf.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1996185",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1996185/full",
  "id": "f9w4vwvqzjqzf",
  "issns": [
    "1664-3224"
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  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1996185/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC581-607"
    ],
    [
      "openalex",
      "2720|Hematopoietic Stem Cell Transplantation"
    ]
  ],
  "openalex": "W7223652979",
  "pdf_url": "https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1996185/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-26",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/f9w4vwvqzjqzf.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:17Z",
      "native_id": "10.3389/fimmu.2026.1996185",
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      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1996185/full"
    },
    {
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  "subjects": [
    {
      "field": "biology",
      "origin": "issn:1664-3224",
      "subfield": "immunology"
    },
    {
      "field": "medicine",
      "origin": "lcc:RC581-607",
      "subfield": "general"
    }
  ],
  "title": "Kinetics of early immune reconstitution and its exploratory association with post-transplant outcomes in patients undergoing haploidentical HCT with post-transplant cyclophosphamide-based GvHD prophylaxis",
  "title_text": "Kinetics of early immune reconstitution and its exploratory association with post-transplant outcomes in patients undergoing haploidentical HCT with post-transplant cyclophosphamide-based GvHD prophylaxis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:47:31Z",
  "url": "https://research.draconitic.com/paper/f9w4vwvqzjqzf",
  "venue": "Frontiers in Immunology",
  "versions": []
}