title: The dose of infused lymphocytes in the autograft directly correlates with clinical outcome after autologous peripheral blood hematopoietic stem cell transplantation in multiple myeloma.
abstract: Absolute lymphocyte count at day 15 (ALC-15) after autologous peripheral blood hematopoietic stem cell transplantation (APHSCT) is an independent prognostic factor for survival in multiple myeloma (MM); however, factors affecting ALC-15 in MM remain unknown. We hypothesized that the dose of infused peripheral blood autograft lymphocytes (autograft absolute lymphocyte count: A-ALC) impacts ALC-15 recovery. Between 1989 and 2001, 267 consecutive MM patients underwent APHSCT. We set out to determine the correlation between A-ALC and ALC-15 and the utility of A-ALC as a marker for ALC-15 recovery. A-ALC was found to be both a strong predictor for area under curve (AUC=0.93; P=0.0001) and strongly correlated with (r(s)=0.83; P=0.0001) ALC-15 recovery. Higher infused A-ALC was significantly correlated with an ALC-15>/=500/microl. In addition, median post-transplant overall survival (OS) and time to progression (TTP) were longer in patients who received an A-ALC>/=0.5 x 10(9) lymphocytes/kg versus A-ALC <0.5 x 10(9) lymphocytes/kg (58 vs 30 months, P=0.00022; 22 vs 15 months, P<0.00012, respectively). Multivariate analysis demonstrated A-ALC as an independent prognostic indicator for OS and TTP. These results indicate that an infused dose of autograft lymphocytes significantly impacts clinical outcome post-APHSCT in MM.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. porrata.luis@mayo.edu
authors.forename: L F
authors.initials: LF
authors.lastname: Porrata
authors.forename: M A
authors.initials: MA
authors.lastname: Gertz
authors.forename: S M
authors.initials: SM
authors.lastname: Geyer
authors.forename: M R
authors.initials: MR
authors.lastname: Litzow
authors.forename: D A
authors.initials: DA
authors.lastname: Gastineau
authors.forename: S B
authors.initials: SB
authors.lastname: Moore
authors.forename: A A
authors.initials: AA
authors.lastname: Pineda
authors.forename: K L
authors.initials: KL
authors.lastname: Bundy
authors.forename: D J
authors.initials: DJ
authors.lastname: Padley
authors.forename: D
authors.initials: D
authors.lastname: Persky
authors.forename: M Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: A
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: D S
authors.initials: DS
authors.lastname: Snow
authors.forename: S N
authors.initials: SN
authors.lastname: Markovic
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology* / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D014182:Transplantation, Autologous