Mobilization characteristics, blood graft composition, and outcome in diffuse large B‐cell lymphoma after autologous stem cell transplantation: Results from the prospective multicenter GOA study

Abstract

Background Diffuse large B‐cell lymphoma (DLBCL) is a common indication for autologous stem cell transplantation (auto‐SCT). Study Design and Methods This prospective noninterventional study aimed to evaluate the impact of mobilization characteristics and graft cellular content on hematologic recovery and outcome after auto‐SCT among 68 patients with DLBCL. Results Better mobilization capacity as manifested by blood CD34+ cell count >32 × 106/L and CD34+ cell yield of the first apheresis >2.75 × 106/kg correlated with faster neutrophil (P = .005 and P = .017) and platelet (P = .002 and P < .001) recovery. A higher number of infused CD34+ cells (> 2.65 × 106/kg) was associated with better 5‐year overall survival (OS; 95% vs 67%, P = .012). The graft CD34+CD133+CD38− cell count >0.07 × 106/kg was predictive of better 5‐year OS (87% vs 63%; P = .008) and higher graft CD3+ cell count (>23.1 × 106/kg) correlated also with better 5‐year OS (80% vs 40%, P = .008). In multivariate analysis only disease status of CR I at auto‐SCT was associated with better progression‐free survival (P = .014) and OS (P = .039). Conclusion The mobilization capacity of CD34+ cells impacted on early hematologic recovery in patients with DLBCL after auto‐SCT. Higher graft CD34+ cell count and both CD34+CD133+CD38− and CD3+ cells were also associated with better OS. The effect of optimal graft cellular composition on outcome in DLBCL should be evaluated in a randomized study.

Blood Graft and Outcome After Autologous Stem Cell Transplantation in Patients With Primary Central Nervous System Lymphoma

“…The MATRix combination was used in our study for the majority of the patients before BBBD treatment, which in turn has been proven to result in high remission rates before auto-SCT in a recent retrospective study [ 32 ] and also in a successful strategy for disease control during very long follow-up [ 32 ]. In the present study, a great majority (82%) of patients achieved CR before auto-SCT, but in contrast to previous report regarding DLBCL patients [ 18 ], we did not find any correlations with pretransplant disease status and survival possibly due to small study population.…”

“…Until now, the optimal thresholds of autograft cellular composition to be infused for lymphoma patients have not been established even if the most important parameter of graft quality has suggested to be the graft CD34 + cell content [ 15 - 17 ]. In the most recent prospective study of DLBCL patients including also some PCNSL patients [ 18 ], a cut-off point > 2.65 × 10 6 /kg of CD34 + cells infused was associated with not only more rapid hematologic recovery but in line with previous retrospective observations [ 19 , 20 ] also with better overall survival (OS). Higher CD34 + CD133 + CD38 - cell content of the graft has been shown to hasten hematologic recovery after auto-SCT [ 21 ] and in DLBCL patients also to correlate with better 5-year OS [ 18 ].…”

“…In the most recent prospective study of DLBCL patients including also some PCNSL patients [ 18 ], a cut-off point > 2.65 × 10 6 /kg of CD34 + cells infused was associated with not only more rapid hematologic recovery but in line with previous retrospective observations [ 19 , 20 ] also with better overall survival (OS). Higher CD34 + CD133 + CD38 - cell content of the graft has been shown to hasten hematologic recovery after auto-SCT [ 21 ] and in DLBCL patients also to correlate with better 5-year OS [ 18 ]. In previous studies, a higher amount of natural killer (NK) cells in the grafts has been linked with earlier lymphocyte recovery and also with better outcome [ 22 - 24 ].…”

“…In previous studies, a higher amount of natural killer (NK) cells in the grafts has been linked with earlier lymphocyte recovery and also with better outcome [ 22 - 24 ]. In addition, the most recent prospective study showed a positive correlation between the number of infused CD3 + cells and outcome in DLBCL patients mostly with systemic disease [ 18 ].…”

Use of Plerixafor for Stem Cell Mobilization in the Setting of Autologous and Allogeneic Stem Cell Transplantations: An Update

“… 10 Further, a recent study showed a better 5-year overall survival when the patients are transplanted with higher number of CD34+ cells (>2.65×10 6 /kg). 11 …”