Clinical analysis of B-cell lymphoma treatment with autologous hematopoietic stem cell transplantation

Abstract

Objective To investigate the clinical efficacy, safety and prognostic factors of autologous hematopoietic stem cell transplantation (auto-HSCT) in treatment of B-cell lymphoma. Methods From March 2001 to December 2014, a total of 50 patients with B-cell lymphoma who underwent auto-HSCT at Tangdu Hospital, the Fourth Military Medical University were selected as the study subjects. Among them, 24 patients were suffering from diffuse large B-cell lymphoma (DLBCL), 2 patients were suffering from follicular lymphoma (FL), 3 patients were suffering from B lymphoblastic lymphoma, 21 patients were suffering from B-cell lymphoma (undifferentiated). According to number of times of receiving auto-HSCT, these 50 patients were divided into two groups: single auto-HSCT group (n=28, only receiving auto-HSCT once) and double autologous hematopoietic stem cell transplantation (DAHSCT) group (n=22, the second auto-HSCT was planned in 2 to 6 months after the first auto-HSCT). Retrospective method was used to collect related clinical data from all patients. The severity of post-transplant adverse events was assessed according to the Common Criteria for Terminology of Incidents, version 4.0 (CTCAE v4.0). The efficacy of auto-HSCT was evaluated according to revised International Working Group (IWG) lymphoma efficacy criteria and the overall response rate of auto-HSCT was calculated. Survival analysis was performed using Kaplan-Meier method. Overall survival (OS) and progression-free survival (PFS) rates were compared between two groups using log-rank test. Cox regression analysis was used to univariate analyze the influencing factors that may influence the OS peroid of B-cell lymphoma patients in this study. According to available research results and clinical experience, multivariate Cox regression analysis was performed on the factors that were statistically significant in the univariate analysis. Results ①The differences of composition ratios of clinical stage and age-adjusted international prognostic index (aaIPI) score in single auto-HSCT group and DAHSCT group were significantly (composition ratio of patients with clinical stage Ⅰ-Ⅱ: 25.0% vs 54.5%, χ2=4.565, P=0.033; Composition ratio of patients with aaIPI 0-2: 35.7% vs 86.4%, χ2=12.974, P 0.05). ④ In single auto-HSCT group, 18 patients achieved complete remission (CR) and 8 patients achieved partial remission (PR), with the total response rate of auto-HSCT of 92.9% (26/28). In DAHSCT group, 20 patients achieved CR and 2 patients achieved PR, with the total response rate of DAHSCT of 100.0% (22/22). The median follow-up time was 54.0 months (24.8-76.3 months) in this study, and OS rate was 68.0%, PFS rate was 52.0%. OS rate and PFS rate were 77.3% and 68.2% in the DAHSCT group, which were both higher than that of 60.7% and 39.3% in the single auto-HSCT group respectively, and the differences were statistically significant (χ2=8.073, 4.250; P=0.004, 0.039). ⑤ The results of univariate Cox regression analysis showed that level of serum lactate dehydrogenase (LDH) and number of times of auto-HSCT were the risk factors influencing OS period in patients with B-cell lymphoma (P=0.033, 0.045). And results of multivariate Cox regression analysis showed that serum LDH levels>245 U/L and single auto-HSCT were independent risk factors for OS period of patients with B-cell lymphoma (HR=0.237, 95%CI: 0.062-0.905, P=0.035; HR=3.063, 95%CI: 0.970-9.675, P=0.047) in this study. Conclusions Auto-HSCT treatment of patients with B-cell lymphoma were with good efficacy, tolerability and safety, which is worth further clinical application. Key words: Lymphoma, B cells; Hematopoietic stem cell transplantation; Transplantation, autologous