The Karolinska experience of autologous stem-cell transplantation for lymphoma: a population-based study of all 433 patients 1994-2016

Background: Autologous stem-cell transplantation (ASCT) is a common treatment for lymphoma but it has some mortality.

Methods: All 433 lymphoma patients who underwent ASCT for lymphoma at Karolinska Huddinge 1994-2016 were investigated, including CD34⁺ cell amounts, medications, infectious and other complications, intensive care, longitudinal laboratory values, and secondary myeloid neoplasia.

Results: The 100-day non-relapse and overall mortalities were 5.6% and 7.2%. Stem-cell harvests < 5 million CD34⁺ cells/kg correlated with inferior 100-day and long-term survival. Prior to conditioning (93% BEAM), elevated (both 3-9 and ≥ 10 mg/L) C-reactive protein (CRP) and creatinine, and low albumin (but not higher age) predicted inferior higher 100-day survival. Intravenous antibiotics were given to 97% (22% positive blood cultures) and parenteral nutrition to 89%. After 1 year, 86% had normalized hemoglobin. The 5-year risk for secondary myeloid neoplasia was 4.1%, associated with smaller harvests.

Conclusions: Before starting conditioning, patients should have preferably harvested ≥ 5 million CD34⁺ cells/kg and normal CRP, albumin, and creatinine. It appears safe to transplant patients ≥ 66 years.