Larger number of invariant natural killer T cells in PBSC allografts correlates with improved GVHD-free and progression-free survival

Key Points • Higher dose of invariant NKT cells within PBSC allograft is associated with an improved GPFS. We studied the impact of a set of immune cells contained within granulocyte colony-stimulating factor–mobilized peripheral blood stem cell grafts (na¨ivena¨ive and memory T-cell subsets, B cells, regulatory T cells, invariant natural killer T cells [iNKTs], NK cells, and dendritic cell subsets) in patients (n 5 80) undergoing allogeneic stem cell trans-plantation (SCT), using the composite end point of graft-versus-host disease (GVHD)-free and progression-free survival (GPFS) as the primary end point. We observed that GPFS incidences in patients receiving iNKT doses above and below the median were 49% vs 22%, respectively (P 5 .007). In multivariate analysis, the iNKT dose was the only parameter with a significant impact on GPFS (hazard ratio 5 0.48; 95% confidence interval, 0.27-0.85; P 5 .01). The incidences of severe grade III to IV acute GVHD and National Institutes of Health grade 2 to 3 chronic GVHD (12% and 16%, respectively) were low and associated with the use of antithymocyte globulin in 91% of patients. No difference in GVHD incidence was reported according to the iNKT dose. In conclusion, a higher dose of iNKTs within the graft is associated with an improved GPFS. These data may pave the way for prospective and active interventions aiming to manipulate the graft content to improve allo