Original Article
The effect and safety of first-line autologous hematopoietic stem cell transplantation in elderly patients with moderate/high-risk diffuse large B-cell lymphoma
Ye Peipei, Lu Ying, Hu Youqian, Cao Junjie, Chen Lieguang, Zhang Pisheng, Chen Dong, Liu Xuhui, Du Xiaohong, Chen Yao, Pei Renzhi
Published 2023-02-14
Cite as Chin J Geriatr, 2023, 42(2): 182-187. DOI: 10.3760/cma.j.issn.0254-9026.2023.02.008
Abstract
ObjectiveTo investigate the efficacy and related influencing factors of autologous hematopoietic stem cell transplantation(auto-HSCT)as first-line consolidation therapy for newly diagnosed elderly patients with diffuse large B cell lymphoma(DLBCL).
MethodsRetrospective study of clinical characteristics, therapeutic effect, and prognostic factors of newly diagnosed DLBCL elderly patients with an International Prognostic Index(IPI)score≥3 who underwent auto-HSCT in the Affiliated People's Hospital of Ningbo University from January 2015 to August 2020.
ResultsAmong the 31 patients, 18 were males and 13 were females, with a median age of 65(60-75)years.The 13 cases(41.9%)were involved in 2 sites outside lymph nodes, and 13 cases(41.9%)were involved in bone marrow.IPI medium and high risk(IPI=3 points)was found in 21 cases(67.7%), high risk(≥4 points)in 10 cases(32.2%). Before transplantation, 21(67.7%)patients achieved complete remission(CR), and the other 10(32.3%)patients were in the partial remission(PR). All patients after transplantation achieved hematopoietic reconstitution.The median time for neutrophil and platelet engraftment were 10(9-16)days and 12(8-58)days respectively.During a median follow-up of 20.9(3.1 to 73.0)months after transplantation, transplant-related mortality within 100 days was 3.2%(1/31). The 2-year overall survival(OS)and progression-free survival(PFS)were(77.2±8.4)% and(72.7±8.3)%, respectively.Multivariate Cox analysis showed that the achieved partial remission status before auto-hematopoietic stem cell transplantation[OS(HR=30.064, 95%CI: 2.231-405.209, P=0.010), PFS(HR=9.165, 95%CI: 1.926-43.606, P=0.005)], and CD34+ cell count in graft <3×106/kg[OS(HR=12.004, 95%CI: 1.234-116.807, P=0.032), PFS(HR=6.115, 95%CI: 1.325-28.221, P=0.020)]were the independent poor prognostic factor affecting both OS and PFS in elderly lymphoma patients.
ConclusionsAuto-HSCT may improve the survival rate of carefully selected elderly patients with DLBCL.Pretransplant disease status and the number of CD34+ cells in the graft are important factors to predict the efficiency of auto-HSCT of the patients.
Key words:
Lymphoma, large B-cell, diffuse; Hematopoietic stem cell transplantation; Treatment outcome; Prognosis
Contributor Information
Ye Peipei
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Lu Ying
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Hu Youqian
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Cao Junjie
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Chen Lieguang
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Zhang Pisheng
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Chen Dong
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Liu Xuhui
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Du Xiaohong
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Chen Yao
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
Pei Renzhi
Department of Hematology, the Affiliated People's Hospital of Ningbo University, Ningbo 315100, China
