CD34+ cell mobilization, blood graft composition, and post-transplant recovery differ between patients with multiple myeloma (MM) and those with non-Hodgkin lymphoma (NHL) undergoing autologous stem cell transplantation (ASCT), according to research published in Transfusion.
ASCT is commonly used in both MM and NHL treatment, though the settings under which the procedure is undertaken differ. In MM, many eligible patients receive ASCT after induction therapy, while patients with diffuse large B-cell lymphoma may undergo ASCT only after relapse. Mobilizing agents are almost always used alongside ASCT include granulocyte-colony–stimulating factor (G-CSF) with or without chemotherapy. Recently, plerixafor has been incorporated into treatments, especially in cases of insufficient mobilization.
Higher graft CD34+ cell content is linked to improved platelet and neutrophil recovery after high-dose therapy. CD34+ cell count is an important marker of graft quality in the ASCT setting and higher counts may be linked to improved progression-free survival (PFS) and overall survival (OS). While patient characteristics may affect the ability to mobilize CD34+ cells for transplant purposes, some research suggests that mobilization is poorer among patients with NHL than in those with MM.
The Graft and Outcome in Autologous Stem Cell Transplantation (GOA) study was prospective multicenter analysis designed to evaluate mobilization methods and outcomes among patients undergoing ASCT. The researchers “compared MM patients with NHL patients regarding mobilization and apheresis of CD34+ cells, cellular composition of infused blood grafts, recovery of blood counts, and complications post-transplant.”
Of the 284 patients included in this analysis, 147 participants had MM and 137 had NHL. The median ages for patients with MM and NHL were 64 years and 62 years, respectively. All patients with NHL underwent mobilization with G-CSF and chemotherapy compared with 61% of patients with MM; the remaining 39% of patients with MM underwent mobilization with G-CSF only. In addition, plerixafor was used more among patients with NHL (36%) vs MM (12%).
Patients with MM had better CD34+ mobilization compared with patients with NHL (6.3 × 106/kg vs 3.9 x 106/kg, respectively; P <.001). Compared with patients with NHL, patients with MM had more natural killer and CD34+ cells in grafts and higher post-transplant platelet and natural killer cell counts.
Nonrelapse mortality at more than 100 days was low in both groups, but was higher among patients with NHL (6%) than among those with MM (0%; P =.003).
“Further analyses are needed to evaluate the potential effects of different graft cellular components on post-transplant recovery and outcome,” the authors wrote.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Turunen A, Partanen A, Valtola J, et al. CD34+ cell mobilization, blood graft composition, and posttransplant recovery in myeloma patients compared to non-Hodgkin’s lymphoma patients: results of the prospective multicenter Goa study [published online April 24, 2020]. Transfusion. doi: 10.1111/trf.15820