Early lymphocyte recovery after autologous stem cell transplantation predicts superior survival in mantle-cell lymphoma

Abstract

Autologous stem cell transplantation (ASCT) is an effective treatment strategy for mantle-cell lymphoma (MCL) demonstrating significantly prolonged progression-free survival (PFS) when compared to interferon-a maintenance therapy of patients in first remission. The study of absolute lymphocyte count at day 15 (ALC-15) after ASCT as a prognostic factor in non-Hodgkin lymphoma (NHL) included different lymphoma subtypes. The relationship of ALC-15 after ASCT in MCL has not been specifically addressed. We evaluated the impact of ALC-15 recovery on survival of MCL patients undergoing ASCT. We studied 42 consecutive MCL patients who underwent ASCT at the Mayo Clinic in Rochester from 1993 to 2005. ALC-15 threshold was set at 500 cells/ll. The median follow-up after ASCT was 25 months (range, 2-106 months). The median overall survival (OS) and PFS times were significantly better for the 24 patients who achieved an ALC-15 X500 cells/ll compared with 18 patients with ALC-15 o500 cells/ll (not reached vs 30 months, Po0.01 and not reached vs 16 months, Po0.0006, respectively). Multivariate analysis demonstrated ALC-15 to be an independent prognostic factor for OS and PFS. The ALC-15 X500 cells/ll is associated with a significantly improved clinical outcome following ASCT in MCL.

The relationship between absolute lymphocyte count with PFS in patients with Hodgkin's lymphoma undergoing autologous hematopoietic cell transplant

“…In contrast to prior studies, 5,7,8,25,26 we did not find any association at all with ALC-15 and PFS. We are in the process of designing a prospective trial to evaluate immune reconstitution focusing on lymphocyte subsets such as naive and regulatory T cells in patients with a hematological malignancy following AHCT to better understand the biologic basis of these observations.…”

“…4 Recovery of PBL (40.5 Â 10 9 per liter by day 15 post-AHCT) has also been related to improved PFS and overall survival (OS) in transplanted HL patients. 5,6 These findings have also been demonstrated in patients with other lymphoma subtypes 7 and myeloma 8 undergoing AHCT. Our study was undertaken to further evaluate the relationship between the absolute lymphocyte count (ALC) at the time of apheresis and ALC recovery at two time points after AHCT, with PFS in a group of uniformly treated patients with relapsed or refractory HL.…”

Importance of blood graft characteristics in auto-SCT: implications for optimizing mobilization regimens

“…There are several reports suggesting lower risk of relapse and thus better PFS in patients with rapid lymphocyte recovery defined as the Optimizing blood graft content in auto-SCT E Jantunen and S Fruehauf absolute lymphocyte count on day þ 15 after stem-cell infusion. [28][29][30][31][32][33][34][35][36][37][38][39] These studies are summarized in Table 3. The number of lymphocytes within the graft infused seems to have prognostic significance potentially by affecting early lymphocyte recovery.…”

“…62 Several studies suggest that the risk of infectious complications, especially those of viral origin, is increased in patients receiving CD34 þ cell selected grafts, [63][64][65][66] although not all studies have noted this association. 58,67,68 35 NHL 274 ALC-15 independent prognostic factor for PFS and OS Joao 36 NHL/MCL 42 ALC-15 an independent prognostic factor for PFS and OS Tiwari 37 NHL 268 no association with ALC-15 and DFS or OS Porrata 39 NHL 50 NK cell recovery independent predictor for survival Porrata 28 MM 126 ALC-15 associated with better PFS and OS Hiwase 38 MM 119 ALC-30 associated with better PFS and OS Porrata 33 AL 145 ALC-15 independent prognostic factor for PFS and OS Nieto 31 MBC Optimizing blood graft content in auto-SCT E Jantunen and S Fruehauf…”

Characterization of hemopoietic engraftment kinetics and development of secondary cytopenia in AML post auto-SCT and its correlation with survival outcome

“…19 Early lymphocyte recovery following hemopoietic SCT has also been used as a predictive factor for prolonged survival in patients with many hematological malignancies. [20][21][22][23][24] Porrata et al 25 in their study reported that, in case of AML, a recovery of the absolute lymphocyte count (ALC) X0.5 Â 10 9 cells/l on day 15 post-autologous transplantation was associated with improved survival in their patients.…”