Study of the Relationship of Product Infused with Survival in Patients with Hodgkin’s Disease and No Hodgkin’s Lymphoma Undergoing Autologus Stem Cell Transplantation

Absolute lymphocyte count (ALC) at diagnosis (ALC-D), as well as ALC recovery, have been described as prognostic factors in overall survival (OS) and progression free survival (PFS) in patients with non-Hodgkin’s and Hodgkin’s lymphoma(NHL and HL) who underwent autologous stem cell transplantation (ASCT). The aim of this study is to verify those findings, as well as the influence of infused lymphocyte, MNC, CD19 and CD3 in OS and PFS in our patients, in order to give some support to the importance of the immune system for disease control.

A total of 55 patients were reviewed, 35 males and 20 females, 44 had NHL and 12 HL. Variables analyzed with regard to PFS and OS were: ALC-D, ALC at day 15 post-transplant (ALC15), infused lymphocyte ×10⁶/Kg, MNC X10⁸ / Kg, CD19 X10⁶/ Kg and CD3×10⁶/ Kg. Variables were dichotomized at the median, and PFS and OS estimates were calculated with the Kaplan-Meier method and compared using log-rank test; regression Cox test was used for multivariate study.

Results: The median follow-up was 71 months (14–180). Relapse or progression occurred in 20 patients (36%) between 1 and 148 months (median 32). Eighteen patients (33%) died at a median of 28 months (14–110). Median ALC-D was 1.5×10⁹/L (0.2–5.2 ×10⁹/L). ALC15 count was 0.6 ×10⁹/L (0.1–1.9). Infused MNC were 5.0×10⁸/Kg (0.04– 22.2). Infused lymphocytes were 241.6 ×10⁶/Kg (0.1–1222). Median CD19 cells infused were 1.12 ×10⁶/Kg (0.0–79.7). Infused CD3 cells were 106.8 ×10⁶/Kg (0.02–678.2). No difference was found in OS or PFS in patients in groups above and below median in ALC-D, ALC15 counts, neither in MNC, lymphocytes, CD19 nor CD3 cells infused in Kaplan-Meier study. MNC infused have statistical significance in OS (p=0.042) and PFS (p=0.023) in Cox regression analysis. In our series we do not find a clear predictor in relation to the immune reconstitution in NHL and HL patients receiving an ASCT; althoug it is possible that among MNC should be immune progenitors able to offer a better outcome to these patients, that could be studied in future.