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Background High-dose chemotherapy followed by autologous stem cell transplantation is considered a standard treatment approach for patients with relapsed Hodgkin's lymphoma (HL) and non-Hodgkin lymphoma (NHL). The goal of autologous stem cell transplant in relapsed lymphoma is to achieve long-term disease control, i.e., cure, in contrast to disorders like multiple myeloma, where it only prolongs the duration of remission, progression-free survival, and improves the quality of life. Published outcomes of high-dose therapy and ASCT and the impact of different factors affecting survival in low- to middle-income countries are very limited. Our study analyzed all the autologous stem cell transplants performed in our center over a six-year period to ascertain engraftment, responses, outcomes, and variables that may have impacted transplant outcomes. Methods We conducted a retrospective study including 76 patients from January 2015 to December 2020. Data were retrieved from electronic medical records at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Results Out of a total of 82 autologous transplant patients, 76 were eligible for the study, out of which 50 (66%) had HL and 26 (34%) had NHL. The median age was 29 years (range 18-53) and 29 years (range 20-45) for HL and NHL, respectively. The male-to-female ratio was 5:2 and 4:1 for HL and NHL, respectively. The majority had advanced-stage disease, 85% in HL and 75% in NHL. The minimum cell dose infused was 2.5 million CD34+ cells/kg. Median days to platelets and ANC engraftment were 14 and 11 days, respectively. The 30-day transplant-related mortality was 8.9% and 7.4% in HL and NHL, respectively. The 100-day mortality was 15.2% and 11% in HL and NHL, respectively. The two-year disease-free survival (DFS) and overall survival (OS) were 83% and 83%, respectively, in HL patients. The two-year DFS and OS were 78% and 85%, respectively, in NHL patients. Conclusion High-dose therapy and autologous stem cell transplantation in low- to middle-income countries are limited to relatively younger patients, potentially curative conditions such as lymphoma, and predominantly after achieving a complete response to salvage therapy due to limited resources. Due to these factors, our study shows excellent response rates and survival outcomes compared to internationally published data. Engraftment was also excellent and comparable to published data despite the non-controlled rate freezing of peripheral blood stem cells.
RESUMO
BACKGROUND: Anaemia is a common feature of lympho-proliferative disorders and is an important cause of poor quality of life in these patients. When indicated, packed red blood cells (PRBC) units are transfused to treat anaemia. Objective of this study was to identify risk factors associated with PRBC transfusions in lymphoma patients. METHODS: This was a retrospective study done on Hodgkin lymphoma (HL) and Non-Hodgkin lymphoma (NHL) patients who had PRBC transfusions during chemotherapy. Information regarding gender, type of lymphoma, stage, baseline haemoglobin, marrow involvement and total number of PRBC units transfused was collected. RESULTS: A total of 481 patients with diagnosis of HL and NHL were registered during one year period. Out of these, 108 (22.4%) had PRBC transfusions during treatment. HL and NHL patients were 30 (27.8%) and 78 (72.2%) respectively. NHL patients were older than HL (37 vs. 32 years), (p=0.03). HL patients had lower mean haemoglobin 9.3 +/- 2.56 g/dl as compared to NHL 11.33 +/- 2.42 g/dl, (p<0.05). There was significant difference in number of PRBC units transfused based on lymphoma type (NHL 6.74 +/- 5.69 vs. HL 3.97 +/- 3.0 units, p<0.05). Bone marrow involvement resulted in increased transfusion requirements (7.84 +/- 4.36 vs. 5.26 +/- 5.49 units, p<0.05) while stage of disease didn't affected significantly (I/II--4.88 +/- 4.85 and III/IV 6.30 +/- 5.33 units p=0.2). CONCLUSION: A significant number of lymphoma patients need PRBC transfusions during chemotherapy. NHL patients and bone marrow involvement makes patients at higher risk for transfusions. In places, where blood bank support is not adequate, patients should be informed right from beginning to arrange donors for possible transfusions during chemotherapy.
