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Analysis of absolute lymphocyte count and other factors predicting survival in patients with Hodgkin’s lymphoma following autologous stem cell transplantation


Authors: H. Mociková;  B. Vacková;  R. Pytlík;  P. Obrtlíková;  M. Trněný
Authors‘ workplace: Univerzita Karlova v Praze, 1. lékařská fakulta, I. interní klinika – klinika hematologie 1. LF a VFN
Published in: Transfuze Hematol. dnes,16, 2010, No. 1, p. 25-29.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

Introduction.
This retrospective study analyzed risk factors predicting treatment failure and survival in patients with Hodgkinęs lymphoma following autologous stem cell transplantation. Analyzed factors: absolute lymphocyte counts prior to stem cell collection, day+15 and day +90 following transplantation, age at transplantation, clinical stage at relapse, progression/early and late relapse, response to salvage chemotherapy, positivity of positron emission tomography prior to transplantation, number of infused CD34+ cells, recovery of neutrophile leucocytes and occurence of serious infections within 6 months following transplantation. Patients and methods. The study analyzed 33 patients treated with autologous transplantation between years 2000 and 2008. Median age was 34 years, 17 relapsed patients (51%) were in clinical stage III or IV. Early relapse within one year after previous therapy was diagnosed in 15 patients (45%). Chemosensitivity of lymphoma prior to transplantation was proved in 21 patients (64%). Positron emission tomography prior to transplantation was offered to 21 patients with persisting positive findings in 10 patients (48%). Median number of infused CD34+ cells was 6.8x106/kg. Median absolute lymphocyte count prior to stem cell collection was 1.2x109/L, day +15 post-transplantation was 0.7x109/L and day +90 post-transplantation was 1.35x109/L. Results. Median follow - up of the group was 3.6 years. 3 - year actuarial overall survival and progression-free survival are 82% and 71%. The only factor significantly associated with progression-free survival in univariate analysis was absolute lymphocyte count day +90 ≥ 0.75x109/L (HR= 0.205, 95% confidence interval: 0.055 – 0.757, p = 0.017). None of analysed factors was predictive for overall or progression-free survival in multivariate analyses. Conclusions. In our study only absolute lymphocyte count day +90 following transplantation with cut-off over 0.75x109/L was significantly associated with improved progression-free survival.

Key words:
autologous stem cell transplantation, therapeutic response, prognostic factors, absolute lymphocyte count


Sources

1. Morschhauser F, Brice P, Ferme Ch, et al. Risk adapted salvage treatment with single or tandem autologous stem-cell transplantation for first relapse/refractory Hodgkin’s lymphoma: results of the prospective multicenter H96 trial by the GELA/SFGM Study Group. J Clin Oncol 2008; 26: 5981–5987.

2. Josting A, Franklin J, May M, et al. New prognostic score based on treatment outcome of patients with relapsed Hodgkin’s lymphoma registered in the database of the German Hodgkin’s lymphoma study group. J Clin Oncol 2002; 20: 221–230.

3. Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomised trial. Lancet 2002; 359: 2065–2071.

4. Crocchiolo R, Canevari C, Assanelli A, et al. Pre-transplant 18FDG-PET predicts outcome in lymphoma patients treated with high-dose sequential chemotherapy followed by autologous stem cell transplantation. Leuk Lymphoma 2008; 49: 727–733.

5. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 1998; 339: 1506–1514.

6. Gordan LN, Sugrue MW, Lynch JW et al. Correlation of early lymphocyte recovery and progression-free survival after autologous stem cell transplant in patients with Hodgkin’s and Non-Hodgkin’s lymphoma. Bone Marrow Transplant 2003; 31: 1009–1013.

7. Porrata LF, Litzow MR, Tefferi A, et al. Early lymphocyte recovery is a predictive factor for prolonged survival after autologous haematopoietic stem cell transplantation for acute myelogenous leukemia. Leukemia 2002; 16: 1311–1318.

8. Porrata LF, Inwards DJ, Micallef IN, et al. Early lymphocyte recovery post-autologous haematopoietic stem cell transplantation is associated with better survival in Hodgkin’s disease. Br J Haematol 2002; 117: 629–633.

9. Bouassel MR, Herr AL, de B Edwardes MD, et al. Early lymphocyte recovery following autologous peripheral stem cell transplantation is associated with better survival in younger patients with lymphoproliferative disorders. Hematology 2006; 11:165–170.

10. Kim H, Sohn HJ, Kim S, et al. Early lymphocyte recovery predicts longer survival after autologous peripheral blood stem cell transplantation in multiple myeloma. Bone Marrow Transplant 2006; 37: 1037–1042.

11. Ovan B, Koc Y, Ozdemir E, et al. High dose sequential chemotherapy and autologous stem cell transplantation in patients with relapsed/refractory lymphoma. Leuk Lymphoma 2006; 47: 1545–1552.

12. Cheson BD, Horning SJ, Coiffier B, et al. Report of an International Workshop to standardize response criteria for non-Hodgkin’s lymphomas. J Clin Oncol 1999; 17: 1244–1253.

13. Brice P, Bouabdallah R, Moreau P, et al. Prognostic factors for survival after high-dose therapy and ASCT for patients with relapsing Hodgkin’s disease:analysis of 280 patients from the French Registry. Bone Marrow Transplant 1997; 20: 21–26.

14. Moskowitz CH, Nimer SD, Zelentz AD, et al. A 2-step comprehensive high-dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin disease: analysis by intent to treat and development of a prognostic model. Blood 2001; 97: 616–623.

15. Josting A, Rudolph C, Mapara M, et al. Cologne high–dose sequential chemotherapy in relapsed and refractory Hodgkin lymphoma: results of a large multicenter study of the German Hodgkin Lymphoma Study Group (GHSG). Ann Oncol 2005; 16: 116–123.

16. Yoon DH, Sohn BS, Jang G, et al. Higher infused CD34+ hematopoietic stem cell dose correlates with earlier lymphocyte recovery and better clinical outcome after autologous stem cell transplantation in non-Hodgkin’s lymphoma. Transfusion 2009 May 11. doi 10.1111/j.1537–2995.2009.02202.x.

17. Oki Y, Yamamoto K, Kato H, et al. Low absolute lymphocyte count is a poor prognostic marker in patients with diffuse large B-cell lymphoma and suggests patient’s survival benefit from rituximab. Eur J Haematol 2008; 81: 448–453.

18. Cox MC, Nofroni I, Ruco L, et al. Low absolute lymphocyte count is a poor prognostic factor in diffuse-large-B-cell-lymphoma. Leuk Lymphoma 2008; 49: 1745–1751.

19. Plonquet A, Haioun C, Jais JP, et al. Peripheral blood natural killer cell count is associated with clinical outcome in patients with aaIPI 2-3 diffuse large B-cell lymphoma. Ann Oncol 2007; 18: 1209–1215.

20. Porrata LF, Ristow K, Habermann TM, et al. Absolute lymphocyte count at the time of first relapse predicts survival in patients with diffuse large B-cell lymphoma. Am J Hematol 2009; 84: 93–97.

21. Joao C, Porrata LF, Inwards DJ, et al. Early lymphocyte recovery after autologous stem cell transplantation predicts superior survival in mantle-cell lymphoma. Bone Marrow Transplant 2006; 37: 865–871.

22. Yoong Y, Porrata LF, Inwards DJ, et al. The effect of absolute lymphocyte count recovery kinetics on survival after autologous stem cell transplantation for non-Hodgkin’s lymphoma. Leuk Lymphoma 2005; 46: 1287–1294.

23. Siddiqui M, Ristow K, Markovic SN, et al. Absolute lymphocyte count predicts overall survival in follicular lymphomas. Br J Haematol 2006; 134: 596–601.

24. Porrata LF, Gertz MA, Inwards DJ, et al. Early lymphocyte recovery predicts superior survival after autologous hematopoietic stem cell transplantation in multiple myeloma or non-Hodgkin lymphoma Blood 2001; 98: 579–585.

25. Seshadri T, Pintilie M, Keating A, et al. The relationship between absolute lymphocyte count with PFS in patients with Hodgkin’s lymphoma undergoing autologous hematopoietic cell transplant. Bone Marrow Transplant 2008; 42: 29–34.

26. Pratt G, Rawstron AC, English AE, et al. Analysis of CD34+ cell subsets in stem cell harvests can more reliably predict rapidity and durability of engraftment than total CD34+ cell dose, but steady state levels do not correlate with bone marrow reserve. Br J Haematol 2001; 114: 937–943.

27. Schot BW, Zjilstra JM, Sluiter WJ, et al. Early FDG-PET assessment in combination with clinical risk scores determines prognosis in recurring lymphoma. Blood 2007; 109: 486–491.

28. Porrata LF, Inwards DJ, Ansell SM, et al. Early lymphocyte recovery predicts superior survival after autologous stem cell transplantation in non-Hodgkin lymphoma: a prospective study. Biol Blood Marrow Transplant 2008; 14: 807–816.

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Haematology Internal medicine Clinical oncology
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