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Abstract
BackgroundAutologous stem-cell transplantation (ASCT) is a common treatment for lymphoma but it has some mortality.MethodsAll 433 lymphoma patients who underwent ASCT for lymphoma at Karolinska Huddinge 1994–2016 were investigated, including CD34+ cell amounts, medications, infectious and other complications, intensive care, longitudinal laboratory values, and secondary myeloid neoplasia.ResultsThe 100-day non-relapse and overall mortalities were 5.6% and 7.2%. Stem-cell harvests < 5 million CD34+ cells/kg correlated with inferior 100-day and long-term survival. Prior to conditioning (93% BEAM), elevated (both 3–9 and ≥ 10 mg/L) C-reactive protein (CRP) and creatinine, and low albumin (but not higher age) predicted inferior higher 100-day survival. Intravenous antibiotics were given to 97% (22% positive blood cultures) and parenteral nutrition to 89%. After 1 year, 86% had normalized hemoglobin. The 5-year risk for secondary myeloid neoplasia was 4.1%, associated with smaller harvests.ConclusionsBefore starting conditioning, patients should have preferably harvested ≥ 5 million CD34+ cells/kg and normal CRP, albumin, and creatinine. It appears safe to transplant patients ≥ 66 years.
Highlights
Autologous stem-cell transplantation (ASCT) is a common treatment for lymphoma but it has some mortality
After decades of ASCT as standard practice and thousands of patients undergoing ASCT worldwide every year, no study has yet systematically explored the predictive role of established pre-transplant clinical and laboratory parameters to identify those at excessive risk for treatment-related mortality (TRM) or non-relapse mortality (NRM)
The 5 million cut-off was significant in long-term overall survival (OS) analysis (Fig. 1c; p = 0.001), and for long-term NRM (p = 0.013)
Summary
Autologous stem-cell transplantation (ASCT) is a common treatment for lymphoma but it has some mortality. Autologous stem-cell transplantation (ASCT) is part of standard therapy for lymphoma. ASCT appears to improve survival in several lymphomas [1,2,3,4,5,6,7], it is associated with a significant treatment-related mortality (TRM; 2.5% to 11%) [6, 8,9,10]. After decades of ASCT as standard practice and thousands of patients undergoing ASCT worldwide every year, no study has yet systematically explored the predictive role of established pre-transplant clinical and laboratory parameters to identify those at excessive risk for TRM or non-relapse mortality (NRM). There is a need to identify robust predictors for TRM
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