RESUMO
BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is a common indication for autologous stem cell transplantation (auto-SCT). STUDY DESIGN AND METHODS: This prospective noninterventional study aimed to evaluate the impact of mobilization characteristics and graft cellular content on hematologic recovery and outcome after auto-SCT among 68 patients with DLBCL. RESULTS: Better mobilization capacity as manifested by blood CD34+ cell count >32 × 106 /L and CD34+ cell yield of the first apheresis >2.75 × 106 /kg correlated with faster neutrophil (P = .005 and P = .017) and platelet (P = .002 and P < .001) recovery. A higher number of infused CD34+ cells (> 2.65 × 106 /kg) was associated with better 5-year overall survival (OS; 95% vs 67%, P = .012). The graft CD34+ CD133+ CD38- cell count >0.07 × 106 /kg was predictive of better 5-year OS (87% vs 63%; P = .008) and higher graft CD3+ cell count (>23.1 × 106 /kg) correlated also with better 5-year OS (80% vs 40%, P = .008). In multivariate analysis only disease status of CR I at auto-SCT was associated with better progression-free survival (P = .014) and OS (P = .039). CONCLUSION: The mobilization capacity of CD34+ cells impacted on early hematologic recovery in patients with DLBCL after auto-SCT. Higher graft CD34+ cell count and both CD34+ CD133+ CD38- and CD3+ cells were also associated with better OS. The effect of optimal graft cellular composition on outcome in DLBCL should be evaluated in a randomized study.
Assuntos
Mobilização de Células-Tronco Hematopoéticas , Linfoma Difuso de Grandes Células B/terapia , Transplante de Células-Tronco de Sangue Periférico/métodos , Adulto , Idoso , Antígenos CD34/análise , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Contagem de Células Sanguíneas , Complexo CD3/análise , Carmustina/administração & dosagem , Carmustina/efeitos adversos , Terapia Combinada , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Citarabina/administração & dosagem , Citarabina/efeitos adversos , Intervalo Livre de Doença , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Neutropenia Febril/induzido quimicamente , Feminino , Filgrastim/farmacologia , Seguimentos , Sobrevivência de Enxerto , Mobilização de Células-Tronco Hematopoéticas/métodos , Células-Tronco Hematopoéticas/química , Humanos , Estimativa de Kaplan-Meier , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Melfalan/administração & dosagem , Melfalan/efeitos adversos , Pessoa de Meia-Idade , Transplante de Células-Tronco de Sangue Periférico/estatística & dados numéricos , Polietilenoglicóis/farmacologia , Intervalo Livre de Progressão , Estudos Prospectivos , Indução de Remissão , Transplante Autólogo , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: In epidemiological studies, chronic inflammation or previous major infection have revealed to be associated with an increased risk of developing Hodgkin lymphoma (HL). The association of chronic inflammation with the disease outcome is poorly defined. In this retrospective study based on 92 consecutive HL patients, we explored the incidence of previous inflammatory processes or previous major infection in newly diagnosed HL patients and their association with treatment outcome. METHODS: Medical history before lymphoma diagnosis including previous infection; dental inflammation; cutaneous problems; and inflammatory respiratory, gastrointestinal, or musculoskeletal diseases was collected from the patient records. Also clinical HL presentation, given treatments, and the disease outcome were recorded. RESULTS: Forty-six percent of HL patients had some of the studied inflammatory factor at the time of diagnosis. Chronic dermatological diseases were present in 16.3% of patients, and they were associated with an improved relapse-free survival (p = 0.028). Dermatological issues were also associated with early-stage disease and the absence of B-symptoms. Other studied inflammatory factors were not associated with any clinical variables or treatment outcome. CONCLUSION: Our results demonstrated that among patients with HL, preexisting cutaneous symptoms are associated with a limited-stage disease, the absence of B-symptoms, and favorable prognosis.