Antti Turunen1,2, Raija Silvennoinen1,3, Anu Partanen1, Jaakko Valtola1, Timo Siitonen4, Mervi Putkonen5, Marja Sankelo6, Marja Pyörälä1, Taru Kuittinen1, Karri Penttilä7,8, Anu Sikiö9, Eeva-Riitta Savolainen10, Pentti Mäntymaa11, Jukka Pelkonen11,12, Ville Varmavuo13, Esa Jantunen1,2,14. 1. Department of Medicine, Kuopio University Hospital, Kuopio, Finland. 2. Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland. 3. Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. 4. Department of Medicine, Oulu University Hospital, Oulu, Finland. 5. Department of Medicine, Turku University Hospital, Turku, Finland. 6. Department of Internal Medicine, Tampere University Hospital, Tampere, Finland. 7. Finnish Medicines Agency, Kuopio, Finland. 8. Department of Medicine, Savonlinna Central Hospital, Savonlinna, Finland. 9. Department of Medicine, Central Hospital of Central Finland, Jyväskylä, Finland. 10. Nordlab, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland. 11. Laboratory Centre of Eastern Finland, Kuopio, Finland. 12. Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland. 13. Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland. 14. Department of Medicine, North Carelia Hospital District, Joensuu, Finland.
Abstract
BACKGROUND: Autologous stem cell transplantation (auto-SCT) is a widely used treatment option in multiple myeloma (MM) patients. The optimal graft cellular composition is not known. STUDY DESIGN AND METHODS: Autograft cellular composition was analyzed after freezing by flow cytometry in 127 MM patients participating in a prospective multicenter study. The impact of graft cellular composition on hematologic recovery and outcome after auto-SCT was evaluated. RESULTS: A higher graft CD34+ cell content predicted faster platelet recovery after auto-SCT in both the short and long term. In patients with standard-risk cytogenetics, a higher graft CD34+ count (>2.5 × 106 /kg) was linked with shorter progression-free survival (PFS; 28 vs. 46 months, p = 0.04), but there was no difference in overall survival (OS) (p = 0.53). In a multivariate model, a higher graft CD34+ CD133+ CD38- (>0.065 × 106 /kg, p = 0.009) and NK cell count (>2.5 × 106 /kg, p = 0.026), lenalidomide maintenance and standard-risk cytogenetics predicted better PFS. In contrast, a higher CD34+ count (>2.5 × 106 /kg, p = 0.015) predicted worse PFS. A very low CD3+ cell count (≤20 × 106 /kg, p = 0.001) in the infused graft and high-risk cytogenetics remained predictive of worse OS. CONCLUSIONS: Autograft cellular composition may impact outcome in MM patients after auto-SCT. More studies are needed to define optimal graft composition.
BACKGROUND: Autologous stem cell transplantation (auto-SCT) is a widely used treatment option in multiple myeloma (MM) patients. The optimal graft cellular composition is not known. STUDY DESIGN AND METHODS: Autograft cellular composition was analyzed after freezing by flow cytometry in 127 MMpatients participating in a prospective multicenter study. The impact of graft cellular composition on hematologic recovery and outcome after auto-SCT was evaluated. RESULTS: A higher graft CD34+ cell content predicted faster platelet recovery after auto-SCT in both the short and long term. In patients with standard-risk cytogenetics, a higher graft CD34+ count (>2.5 × 106 /kg) was linked with shorter progression-free survival (PFS; 28 vs. 46 months, p = 0.04), but there was no difference in overall survival (OS) (p = 0.53). In a multivariate model, a higher graft CD34+ CD133+ CD38- (>0.065 × 106 /kg, p = 0.009) and NK cell count (>2.5 × 106 /kg, p = 0.026), lenalidomide maintenance and standard-risk cytogenetics predicted better PFS. In contrast, a higher CD34+ count (>2.5 × 106 /kg, p = 0.015) predicted worse PFS. A very low CD3+ cell count (≤20 × 106 /kg, p = 0.001) in the infused graft and high-risk cytogenetics remained predictive of worse OS. CONCLUSIONS: Autograft cellular composition may impact outcome in MMpatients after auto-SCT. More studies are needed to define optimal graft composition.
Authors: Luis F Porrata; David J Inwards; Stephen M Ansell; Ivana N Micallef; Patrick B Johnston; Jose C Villasboas; Jonas Paludo; Svetomir N Markovic Journal: EJHaem Date: 2022-02-24