Influence of applied CD34+ cell dose on the survival of Hodgkin's lymphoma and multiple myeloma patients following autologous stem cell transplants

Milena Todorović Balint; Jelena Bila; Bela Balint; Jelena Jeličić; Irena Djunić; Darko Antić; Nada Kraguljac Kurtović; Dragana Vujić; Biljana Mihaljević

doi:10.2298/VSP180808160T

Milena Todorović Balint Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
Jelena Bila Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
Bela Balint Serbian Academy of Science and Arts, Belgrade, Serbia
Jelena Jeličić Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
Irena Djunić Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
Darko Antić Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
Nada Kraguljac Kurtović Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia
Dragana Vujić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Biljana Mihaljević Clinical Center of Serbia, Clinic for Hematology, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP180808160T

Keywords: hematologic neoplasms, stem cells, transplantation, autologous, survival, flow cytometry

Abstract

Background/Aim. Autologous stem cell transplants (ASCTs) improve the rate of overall survival (OS) in patients with hematological malignancies such as multiple myeloma (MM) after induction chemotherapy, aggressive non-Hodgkin's lymphomas (NHL), and relapsed, chemotherapy-sensitive Hodgkin's lymphoma (HL). The study aim was to evaluate influence of applied CD34⁺ cell quantity on clinical outcome, as well as early post-transplant and overall survival (OS) of HL and MM patients following ASCT. Methods. This study included a total of 210 patients (90 HL/120 MM) who underwent ASCT. Stem cell (SC) mobilization was accomplished by granulocyte-colony stimulating factor (G-CSF) 10–16 μg/kg body mass (bm) following chemotherapy. For proven poor mobilizers, mobilization with G-CSF (16 μg/kgbm) and Plerixafor (24 or 48 mg) was performed. To our best knowledge, it was the first usage of the Plerixafor in our country in the ASCT-setting. Harvesting was initiated merely at "cut-off-value" of CD34⁺ cells ≥ 20 × 10⁶/L in peripheral blood with "target-dose" of CD34⁺ cells ≥ 5 × 10⁶/kgbm in harvest. The CD34⁺ cell count and viability was determined using flow cytometry. Results. The majority of HL patients (76.7%) were infused with > 5.0 × 10⁶/kgbm CD34⁺ cells, while 68.3% of MM patients were treated by approximately 4.0–5.4 × 10⁶/kgbm CD34⁺ dose, respectively. Beneficial response (complete/partial remission) was achieved in 83.3% (HL) and 94.2% (MM) patients. Among parameters that influenced survival of HL patients with positive response to the therapy, multivariate analysis (pre-ASCT performance status, CD34⁺ cell quantity applied, rapid hematopoietic, i.e. lymphocyte and platelet recovery) indicated that higher CD34⁺ cell dose used, along with pre-ASCT performance status correlated with superior event-free survival (EFS) and OS following ASCT. In MM patients, multivariate analysis (renal impairment, infused CD34⁺ cell quantity, early platelet recovery) indicated that the number of CD34⁺ cells infused was the most important parameter that influenced both EFS and OS after ASCT. Conclusion. Data obtained in this study undoubtedly confirmed that CD34⁺ cell dose applied is an independent factor that may contribute to superior clinical outcome and OS of HL and MM patients following ASCT.

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