Abstract
SummaryAutograft absolute lymphocyte count (A-ALC) is a prognostic factor for survival in non-Hodgkin lymphoma (NHL) after autologous stem cell transplantation (ASCT). An A-ALC is dependent upon the preaphaeresis absolute lymphocyte count (PA-ALC) at the time of aphaeresis. It was hypothesised that the time interval from last chemotherapy (TILC) to aphaeresis affects PA-ALC. One hundred and sixty consecutive NHL patients who underwent ASCT at the Mayo Clinic between 1996 and 2001 were evaluated. A strong correlation between TILC and PA-ALC (r = 0.67, P < 0.0001) was identified. Higher PA-ALC was observed in TILC ≥55 d compared with TILC <55 d [median: 7.0 vs. 3.8 × 109/l], P < 0.0001). TILC as a continuous variable was identified as a prognostic factor for overall survival (OS) [hazard ratio (HR) = 0.989, P < 0.01] and progression-free survival (PFS) (HR = 0.992, P < 0.0492). Median OS and PFS were longer in the TILC ≥55 d vs. TILC <55 d group (not reached vs. 21 months, P < 0.0008; 76 vs. 9 months, P < 0.0025, respectively). Multivariate analysis demonstrated TILC to be an independent prognostic indicator for OS and PFS. These findings suggest that the immune status of the host at the time of aphaeresis may predict survival after ASCT.
Highlights
Median overall survival (OS) and progression-free survival (PFS) were longer in the time interval from last chemotherapy (TILC) ‡55 d vs. TILC
Multivariate analysis demonstrated TILC to be an independent prognostic indicator for OS and PFS. These findings suggest that the immune status of the host at the time of aphaeresis may predict survival after autologous stem cell transplantation (ASCT)
This study evaluated the hypothesis that preaphaeresis absolute lymphocyte count (PA-ALC) is directly dependent upon the time interval from last chemotherapy (TILC), as a marker of immune recovery time from the myelosuppressive effects of chemotherapy prior to proceeding with aphaeresis collection
Summary
The primary objective of the study was to assess the correlation between TILC and PA-ALC. The secondary objective was to determine the impact on overall survival (OS) and progression-free survival (PFS) based on TILC. The PA-ALC was calculated from the complete blood cell count (CBC) performed prior to each aphaeresis collection. The absolute white blood cell count (WBC) from the autograft was calculated as follows: autograft bag volume (ml) · autograft WBC cells/ml (·109 cells/l) · 0Æ001. The autograft WBC was obtained using the ACT 10 Series Analyzer Coulter, Miami, FL, USA and the percentage of lymphocytes was determined microscopically using Wright stain. The A-ALC for each collection was calculated as follows: [(total absolute WBC) · (% Lymphocytes)]/kg. Absolute lymphocyte count at day 15 (ALC-15) after ASCT was obtained from the CBC at day 15 post-ASCT
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