Autologous Peripheral Blood Stem Cell Transplantation Among Lymphoproliferative Disease Patients: Factors Influencing Engraftment

Abstract

ObjectivesAutologous peripheral blood stem cells transplantation (APBSCT) is a therapeutic option which can be used in various hematological, neoplastic disorders including lymphoproliferative disease (LPD). Differences in patient populations and treatment modalities in different transplant centers mean it is important to improve the knowledge of the different factors affecting engraftment after APBSCT for the success of this procedure. We sought to determine the factors influencing neutrophil and platelet engraftment after APBSCT in patients with LPD.MethodsWe conducted a retrospective review of 70 patients with LPD (35 with lymphoma and 35 with multiple myeloma) who had undergone APBSCT between January 2008 and December 2016. Data obtained included disease type, treatment, and stem cell characteristics. Kaplan-Meier analysis was performed for probabilities of neutrophil and platelet engraftment occurred and was compared by the log-rank test. The multivariate Cox proportional hazards regression model was used for the analysis of potential independent factors influencing engraftment. A p-value < 0.050 was considered statistically significant.ResultsMost patients were ethnic Malay, the median age at transplantation was 49.5 years. Neutrophil and platelet engraftment occurred in a median time of 18 (range 4–65) and 17 (range 6–66) days, respectively. The majority of patients showed engraftment with 65 (92.9%) and 63 (90.0%) showing neutrophil and platelet engraftment, respectively. We observed significant differences between neutrophil engraftment and patient’s weight (< 60/≥ 60 kg), stage of disease at diagnosis, number of previous chemotherapy cycles (< 8/≥ 8), and pre-transplant radiotherapy. While for platelet engraftment, we found significant differences with gender, patient’s weight (< 60/≥ 60 kg), pre-transplant radiotherapy, and CD34+ dosage (< 5.0/≥ 5.0 × 106/kg and < 7.0/≥ 7.0 × 106/kg). The stage of disease at diagnosis (p = 0.012) and pre-transplant radiotherapy (p = 0.025) were found to be independent factors for neutrophil engraftment whereas patient’s weight (< 60/≥ 60 kg, p = 0.017), age at transplantation (< 50/≥ 50 years, p = 0.038), and CD34+ dosage (< 7.0/≥ 7.0 × 106/kg, p = 0.002) were found to be independent factors for platelet engraftment.ConclusionsPatients with LPD who presented at an early stage and with no history of radiotherapy had faster neutrophil engraftment after APBSCT, while a younger age at transplantation with a higher dose of CD34+ cells may predict faster platelet engraftment. However, additional studies are necessary for better understanding of engraftment kinetics to improve the success of APBSCT.

A concise review on factors influencing the hematopoietic stem cell transplantation main outcomes

“…Due to fewer cycles of chemotherapy and radiotherapy in the early stages of the disease and less damage to the microenvironment of neutrophils precursors in BM, neutrophil engraftment occurs faster than late stages of the disease. 4…”

“…4 Infusion of ≥7.0 Â 10 6 CD34 + /kg is associated with the significant faster engraftment of platelets. 4 Dimethyl sulfoxide (DMSO) is used as a cryoprotective of HSCs in the freezing and saving process, but it can damage the HSCs during freeze and thaw. Concerning the importance of CD34 + count in graft, a low concentration of DMSO is associated with faster neutrophils and platelets engraftment.…”

“…33 It has been reported about the weight, as a criterion of performance, that the chance of platelet engraftment was 1.93 times faster when patients weight more than 60 kg. 4 Viral infections, such as human herpes virus-6, parvovirus, and cytomegalovirus (CMV), and also the drug use against the infections that can induce myelosuppression (eg, ganciclovir) are associated with graft failure. 24 It is reported that CMV infection is associated with poor graft function in allogenic HSCT.…”

“…After the infusion of hematopoietic stem cells (HSCs), the competition between donor HSCs and host cells in the bone marrow (BM) microenvironment begins, and the transplantation succeeds when the donor HSCs pass the endothelial barrier to home in the lodgment and then start to proliferate 3 . With the rapid engraftment post‐HSCT, there would be less demand for blood component infusion, the less incidence of infections, febrile, and bleeding, reduction in the costs due to the less hospitalization duration, and most importantly, survival rates would be improved 4 . According to the variety of patient populations in transplant centers with different treatment protocols, understanding the effective factors on outcomes is vital 4 .…”

“…With the rapid engraftment post‐HSCT, there would be less demand for blood component infusion, the less incidence of infections, febrile, and bleeding, reduction in the costs due to the less hospitalization duration, and most importantly, survival rates would be improved 4 . According to the variety of patient populations in transplant centers with different treatment protocols, understanding the effective factors on outcomes is vital 4 . Although there are several factors, this study concisely reviews the factors influencing the main outcomes of HSCT and discusses the probable approaches, such as modification of conditioning regimens, graft manipulation, and presentation of predictive markers which could result in better outcomes for the HSCT (Figure 1).…”