The role of autologous stem cell transplantation (ASCT) in aggressive B-cell lymphomas: real-world data from a retrospective single-center analysis

Abstract

Patients with high-risk or relapsed aggressive B-cell lymphomas are characterized by poor prognosis. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) can induce durable remissions in these patients and is potentially curative. Two hundred forty-seven patients with aggressive B-cell lymphomas treated with high-dose chemotherapy and ASCT, either as consolidation after first-line therapy or after salvage therapy for relapsed disease, between 2002 and 2019 at the University Hospital Muenster, were analyzed. The median follow-up of surviving patients was 36 months (range 0–163). Progression-free survival (PFS) and overall survival (OS) after 3 years was 63% and 68%, respectively. After ASCT, 28% of all patients experienced a relapse. The cumulative incidence of non-relapse mortality at day 100 after ASCT was 4%. Multivariate analysis identified remission status at ASCT, age at ASCT, and the numbers of infused CD34+ cells as independent prognostic factors for both PFS and OS. Patients with mantle cell lymphoma (MCL) or primary CNS lymphoma (PCNSL) treated with ASCT in first-line had a superior OS and PFS when compared to patients treated with ASCT in relapsed disease. For patients with diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma (HL), early relapse (< 12 months) after first-line therapy showed a trend towards an inferior PFS and OS. Deaths after ASCT were predominantly caused by lymphoma relapse and/or progression (64%) or due to infections (23%). In conclusion, high-dose chemotherapy followed by ASCT in the era of novel targeted agents remains a feasible and effective approach for patients with high-risk or relapsed aggressive B-cell lymphomas. Remission status and age at ASCT, and the number of infused stem cells were of prognostic relevance.

Age, CD34+ cell dose, conditioning and pre‐transplant cytopenias can help predict transfusion support in lymphoma patients undergoing autologous stem cell transplantation

“…The studied population is representative of the current indications for ASCT in lymphoma [1,14] and consistent with recent registry reports [15,16].…”

“…We chose to focus on transfusion support and relevant clinical information such as the severe toxicities or infectious complications that impact the duration of pancytopenia were not analysed. Evaluating the efficacy of transplantation was outside this study's scope, but the low transplantation-related mortality (0.4%), the duration of admission and the engraftment times were in line with those expected [4,[16][17][18].…”

“…Pre-transplant anaemia increased the time until transfusion independence for both RBC (12 [9.5-21] vs. 7 [0-11]; p < 0.001) and platelets (13 [10-20.5] vs. 11 [9][10][11][12][13][14]; p = 0.028). Similarly, pretransplant thrombocytopenia impacted both times until RBC (10 [6.5-16.5] vs. 6 [0-10]; p < 0.001) and PT (14 [11][12][13][14][15][16][17][18][19][20][21][22] vs. 10 [8-13];…”

“…reflects transfusion independence analysis.Being 60 years of age or older was associated with a longer time until transfusion independence for RBC(10 [5.8-14.3] vs. 7 [0-11]; p = 0.006) and platelets (13[11][12][13][14][15][16][17][18][19] vs. 11[8][9][10][11][12][13][14]; p < 0.001).F I G U R E 1 Transfusion requirement distribution. RBC, red blood cells.Having required plerixafor also resulted in a longer time to transfusion independence for RBC(8.5 [6.3-15.8] vs. 7 [0-11.3]; p = 0.021) and platelets(13.5 [11-18.8] vs. 11[8][9][10][11][12][13][14]; p < 0.001) as well as an infused CD34 + dose <4 Â 10 6 /kg increased time of transfusion dependency for both RBC(9 [0-14] vs. 6 [0-10]; p = 0.011) and platelets (13[10][11][12][13][14][15][16][17] vs. 10 [8-13]; p < 0.001).BEAM conditioning was associated with a longer time until PT independence ( p = 0.003) but did not prolong the time until RBC transfusion independence ( p = 0.081).Having required any RBC transfusion during the 10 days before the infusion was associated with a significant delay in transfusion independence for RBC(15 [6-38] vs. 7 [0-12]; p = 0.002) and platelets (17[11][12][13][14][15][16][17][18][19]…”

CD34+ Cell Mobilization, Autograft Cellular Composition and Outcome in Mantle Cell Lymphoma Patients

“…Several previous studies have demonstrated a linkage between higher collected graft CD34 + cell count and improved survival after ASCT in NHL patients [5][6][7]21]. None of these studies have included more detailed graft composition analyses.…”