The dose of infused lymphocytes in the autograft directly correlates with clinical outcome after autologous peripheral blood hematopoietic stem cell transplantation in multiple myeloma

• Published in: Leukemia Vol. 18; no. 6; pp. 1085 - 1092
• Main Authors: PORRATA, L. F, GERTZ, M. A, LACY, M. Q, DISPENZIERI, A, SNOW, D. S, MARKOVIC, S. N, GEYER, S. M, LITZOW, M. R, GASTINEAU, D. A, MOORE, S. B, PINEDA, A. A, BUNDY, K. L, PADLEY, D. J, PERSKY, D
• Format: Journal Article
• Language: English
• Published: London Nature Publishing 01.06.2004; Nature Publishing Group
• Subjects: Adult; Aged; Amyloidosis; Autografts; Biological and medical sciences; Blood; Bone marrow; Cell number; Clinical outcomes; Correlation; Disease-Free Survival; Drug dosages; Female; Hematologic and hematopoietic diseases; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulinopathies; Immunopathology; Internal medicine; Leukemia; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphocyte Count; Lymphocytes; Lymphoma; Male; Medical prognosis; Medical sciences; Medicine; Middle Aged; Multiple myeloma; Multiple Myeloma - immunology; Multiple Myeloma - mortality; Multiple Myeloma - therapy; Multivariate Analysis; Patients; Peripheral blood; Plasma; Prognosis; Recovery; Recovery (Medical); Retrospective Studies; Stem cell transplantation; Stem cells; Survival; Transplantation; Transplantation, Autologous; United States > US; Immunopathology; multiple myeloma; Prognosis; Hematology; Stem cell; Hematopoietic cell; Homograft; Immune reconstitution; Malignant hemopathy; Myeloma; Blood; absolute lymphocyte recovery; Autograft; Immunoglobulinopathy; Lymphoproliferative syndrome; autologous peripheral blood hematopoietic stem cell transplantation; Graft; infused peripheral blood autograft absolute lymphocyte count; Dose; Blood cell count; Lymphocyte
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/sj.leu.2403341

Absolute lymphocyte count at day 15 (ALC-15) after autologous peripheral blood hematopoietic stem cell transplantation (APHSCT) is an independent prognostic factor for survival in multiple myeloma (MM); however, factors affecting ALC-15 in MM remain unknown. We hypothesized that the dose of infused peripheral blood autograft lymphocytes (autograft absolute lymphocyte count: A-ALC) impacts ALC-15 recovery. Between 1989 and 2001, 267 consecutive MM patients underwent APHSCT. We set out to determine the correlation between A-ALC and ALC-15 and the utility of A-ALC as a marker for ALC-15 recovery. A-ALC was found to be both a strong predictor for area under curve (AUC=0.93; P=0.0001) and strongly correlated with (r(s)=0.83; P=0.0001) ALC-15 recovery. Higher infused A-ALC was significantly correlated with an ALC-15>/=500/microl. In addition, median post-transplant overall survival (OS) and time to progression (TTP) were longer in patients who received an A-ALC>/=0.5 x 10(9) lymphocytes/kg versus A-ALC <0.5 x 10(9) lymphocytes/kg (58 vs 30 months, P=0.00022; 22 vs 15 months, P<0.00012, respectively). Multivariate analysis demonstrated A-ALC as an independent prognostic indicator for OS and TTP. These results indicate that an infused dose of autograft lymphocytes significantly impacts clinical outcome post-APHSCT in MM.