title: New-onset lymphopenia assessed during routine follow-up is a risk factor for relapse postautologous peripheral blood hematopoietic stem cell transplantation in patients with diffuse large B-cell lymphoma.
abstract: A specific predictor during routine follow-up to ascertain risk for postautologous peripheral blood hematopoietic stem cell transplantation (post-APHSCT) relapse in non-Hodgkin lymphoma (NHL) has not been identified. Thus, we studied if new-onset lymphopenia measured by the absolute lymphocyte count (ALC) was a marker of post-APHSCT NHL relapse. ALC was obtained at the time of confirmed relapse, and at last follow-up with no relapse. From 1993 until 2005, 269 patients treated with APHSCT for diffuse large B-cell lymphoma (DLBCL) were included in this study. Patients at last follow-up without relapse (N=137) had a higher ALC compared with those with low ALC at the time of confirmed relapsed (N=132) (median ALC x10(9)/L of 1.66 versus 0.71, P < .0001, respectively). ALC at follow-up was a strong predictor for relapse with an area under the curve (AUC)=0.86 (P < .0001). An ALC <1.0 x 10(9)/L at the time of confirmed relapse had a positive predictive value of 89% and a positive likelihood ratio of 8.4 to predict relapse post-APHSCT. Patients with an ALC > or =1.0 x 10(9)/L (N=147) had a cumulative incidence of relapse of 19% versus 92%, with an ALC <1.0 x 10(9)/L (N=122) (P < .0001). This study suggests that new-onset lymphopenia measured by ALC can be used as marker to assess risk of DLBCL relapse during routine follow-up for after APHSCT.
authors.affiliation: Division of Hematology/Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. porrata.luis@mayo.edu
authors.forename: Luis F
authors.initials: LF
authors.lastname: Porrata
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ansell
authors.forename: Ivana N
authors.initials: IN
authors.lastname: Micallef
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Johnston
authors.forename: William J
authors.initials: WJ
authors.lastname: Hogan
authors.forename: Svetomir N
authors.initials: SN
authors.lastname: Markovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016015:Logistic Models; D018655:Lymphocyte Count; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000276:immunology / Q000628:therapy*; D008231:Lymphopenia / Q000150:complications* / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007770:L-Lactate Dehydrogenase