Factors Associated with Lymphoma Recurrence Following Autologous Stem Cell Transplantation; Data from Isfahan Cancer Center
-
Mehran Sharifi
,
Mohammad Gholamshahi
,
Seyed Amirhossein Dormiani Tabatabaei
,
Seyed Hamed Tooyserkani
,
Ahmad Akhoondi
Abstract
Introduction: Non-responsive or relapsed lymphoma patients may benefit from salvage chemotherapy or high-dose chemotherapy followed by autologous stem cell transplantation (ASCT), an effective treatment, particularly in non-Hodgkin's and Hodgkin's lymphoma. This study aimed to investigate recurrence in these patients and identify associated risk factors. Methods: A retrospective cohort study analyzed outcomes of lymphoma patients undergoing ASCT at Omid Hospital (2016-2020). Comprehensive data on demographics, treatment, underlying disease, recurrence, and pre-transplantation laboratory parameters were collected from hospital records. Follow-up from transplantation to February 2021 allowed for survival and recurrence evaluation using Kaplan-Meier and Cox regression. The study included patients without concurrent plasma cell disorders or other hematological malignancies for a focused lymphoma treatment outcome analysis. Results: Forty-nine lymphoma patients underwent ASCT (21 HL, 42.9%; 28 NHL, 57.1%). Gender distribution was similar (30 males, 61.2%; 19 females, 38.8%; P=0.774). Mean age at transplantation was 38.8 ± 11.15 years (P=0.519 between groups). Recurrence occurred in 14 patients (7 in each group; P=0.523), with a mean recurrence-free survival (RFS) of 25.2 months (95% CI: 21.44-28.96). HL patients had a lower mean RFS and a higher recurrence hazard ratio (HR: 1.25, 95% CI: 0.420-3.76), though not statistically significant (P=0.683). In NHL, older age significantly correlated with recurrence (P=0.030). While male gender and older age were associated with lower survival, only advanced age in NHL significantly predicted decreased survival (HR: 1.167, 95% CI: 1.102-1.197). Conclusions: Male HL patients showed diminished survival and an elevated hazard ratio (not statistically significant). Advanced age significantly predicted reduced survival in NHL patients. Pre-transplant laboratory markers did not significantly predict survival.
References
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22. Merryman RW, Redd RA, Taranto E, Ahmed G, Jeter E, et al. Minimal residual disease in patients with diffuse large B-cell lymphoma undergoing autologous stem cell transplantation. Blood Adv. 2023 Sep 12;7(17):4748-4759. doi: 10.1182/bloodadvances.2022007706. PMID: 36399518; PMCID: PMC10468363.
23. Desai SH, Spinner MA, Evens AM, Sykorova A, Bachanova V, et al. Overall survival of patients with cHL who progress after autologous stem cell transplant: results in the novel agent era. Blood Adv. 2023 Dec 12;7(23):7295-7303. doi: 10.1182/bloodadvances.2023011205. PMID: 37729621; PMCID: PMC10711178.
24. Troppan KT, Schlick K, Deutsch A, Melchardt T, Egle A, et al. C-reactive protein level is a prognostic indicator for survival and improves the predictive ability of the R-IPI score in diffuse large B-cell lymphoma patients. Br J Cancer. 2014 Jul 8;111(1):55-60. doi: 10.1038/bjc.2014.277. Epub 2014 May 29. PMID: 24874478; PMCID: PMC4090740.
25. Lepik KV, Markelov VV. The Role of the Tumor Microenvironment in T-Cell Redirecting Therapies of Large B-Cell Lymphoma: Lessons Learned from CAR-T to Bispecific Antibodies. Cancers (Basel). 2025 Jan 20;17(2):317. doi: 10.3390/cancers17020317. PMID: 39858099; PMCID: PMC11763497.
26. Pasvolsky O, Bassett RL, Ghanem S, Cuglievan B, Tewari P, et al. Characteristics and outcomes of children, adolescents and young adults with relapsed/refractory non-hodgkin lymphoma undergoing autologous stem cell transplant. BMC Cancer. 2023;23(1):1258.
1. Wang HW, Balakrishna JP, Pittaluga S, Jaffe ES. Diagnosis of Hodgkin lymphoma in the modern era. British journal of haematology. 2019;184(1):45-59.
2. Jaffe ES, editor Diagnosis and classification of lymphoma: Impact of technical advances. Seminars in hematology; 2019: Elsevier.
3. Shanbhag S, Ambinder RF. Hodgkin lymphoma: A review and update on recent progress. CA: a cancer journal for clinicians. 2018;68(2):116-32.
4. Jiang M, Bennani NN, Feldman AL. Lymphoma classification update: B-cell non-Hodgkin lymphomas. Expert review of hematology. 2017;10(5):405-15.
5. Kaseb H, Babiker HM. Hodgkin Lymphoma. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29763144.
6. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. 2023 Feb 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32644754.
7. Armitage JO, Gascoyne RD, Lunning MA, Cavalli F. Non-hodgkin lymphoma. The lancet. 2017;390(10091):298-310.
8. Gallamini A, Tarella C, Viviani S, Rossi A, Patti C, et al. Early chemotherapy intensification with escalated BEACOPP in patients with advanced-stage Hodgkin lymphoma with a positive interim positron emission tomography/computed tomography scan after two ABVD cycles: long-term results of the GITIL/FIL HD 0607 trial. Journal of Clinical Oncology. 2018;36(5):454-62.
9. Flinn IW, Van Der Jagt R, Kahl B, Wood P, Hawkins T, et al. First-line treatment of patients with indolent non-Hodgkin lymphoma or mantle-cell lymphoma with bendamustine plus rituximab versus R-CHOP or R-CVP: results of the BRIGHT 5-year follow-up study. Journal of Clinical Oncology. 2019;37(12):984.
10. Husby S, Favero F, Nielsen C, Sørensen BS, Bæch J, et al. Clinical impact of clonal hematopoiesis in patients with lymphoma undergoing ASCT: a national population-based cohort study. Leukemia. 2020;34(12):3256-68.
11. Yamasaki S, Chihara D, Kim S-W, Kawata T, Mizuta S, et al. Risk factors and timing of autologous stem cell transplantation for patients with peripheral T-cell lymphoma. International journal of hematology. 2019;109:175-86.
12. Simensen VC, Smeland KB, Kiserud CE, Dahl AA, Bersvendsen HS, et al. Survivors’ knowledge of their diagnosis, treatment and possible late adverse effects after autologous stem cell transplantation for lymphoma. Acta Oncologica. 2019;58(9):1315-22.
13. Smith J, Jones B, Williams C. Immune reconstitution with high-dose chemotherapy and autologous stem cell transplantation in refractory and relapsed Hodgkin lymphoma: Prognostic factors and outcome from a single-center experience. Bone Marrow Transplant. 2020;55(3):500-8.
14. Philip T, Guglielmi C, Hagenbeek A, Somers R, Van Der Lelie H, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. New England Journal of Medicine. 1995;333(23):1540-5.
15.Dahi PB, Tamari R, Devlin SM, Maloy M, Bhatt V, et al. Favorable outcomes in elderly patients undergoing high-dose therapy and autologous stem cell transplantation for non-Hodgkin lymphoma. Biology of Blood and Marrow Transplantation. 2014;20(12):2004-9.
16. Schorb E, Finke J, Ferreri AJ, Ihorst G, Mikesch K, et al. High-dose chemotherapy and autologous stem cell transplant compared with conventional chemotherapy for consolidation in newly diagnosed primary CNS lymphoma—a randomized phase III trial (MATRix). BMC cancer. 2016;16:1-9.
17. Mariotti J, Ricci F, Giordano L, Taurino D, Sarina B, et al. Outcome of High-Dose Chemotherapy Followed by Autologous Stem Cell Transplantation in Relapsed/Refractory Hodgkin Lymphoma after Different Numbers of Salvage Regimens. Cells. 2024;13(2).
18. Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. The Lancet. 2002;359(9323):2065-71.
19. Taranto E, Redd R, Jeter E, McHugh K, Crombie JL, et al. Prognostic value of minimal residual disease among patients with classical Hodgkin lymphoma undergoing autologous stem cell transplantation. Leuk Lymphoma. 2022 Dec;63(12):2912-2917. doi: 10.1080/10428194.2022.2103808. Epub 2022 Aug 7. PMID: 35938581; PMCID: PMC11165988.
20. Grisariu S, Shapira MY, Or R, Avni B. Thiotepa, Etoposide, Cyclophosphamide, Cytarabine, and Melphalan (TECAM) Conditioning Regimen for Autologous Stem Cell Transplantation in Lymphoma. Clin Lymphoma Myeloma Leuk. 2018 Apr;18(4):272-279. doi: 10.1016/j.clml.2018.02.008. Epub 2018 Feb 15. PMID: 29500148.
21. Sureda A, André M, Borchmann P, da Silva MG, Gisselbrecht C, et al. Improving outcomes after autologous transplantation in relapsed/refractory Hodgkin lymphoma: a European expert perspective. BMC Cancer. 2020 Nov 10;20(1):1088. doi: 10.1186/s12885-020-07561-2. PMID: 33172440; PMCID: PMC7657361.
22. Merryman RW, Redd RA, Taranto E, Ahmed G, Jeter E, et al. Minimal residual disease in patients with diffuse large B-cell lymphoma undergoing autologous stem cell transplantation. Blood Adv. 2023 Sep 12;7(17):4748-4759. doi: 10.1182/bloodadvances.2022007706. PMID: 36399518; PMCID: PMC10468363.
23. Desai SH, Spinner MA, Evens AM, Sykorova A, Bachanova V, et al. Overall survival of patients with cHL who progress after autologous stem cell transplant: results in the novel agent era. Blood Adv. 2023 Dec 12;7(23):7295-7303. doi: 10.1182/bloodadvances.2023011205. PMID: 37729621; PMCID: PMC10711178.
24. Troppan KT, Schlick K, Deutsch A, Melchardt T, Egle A, et al. C-reactive protein level is a prognostic indicator for survival and improves the predictive ability of the R-IPI score in diffuse large B-cell lymphoma patients. Br J Cancer. 2014 Jul 8;111(1):55-60. doi: 10.1038/bjc.2014.277. Epub 2014 May 29. PMID: 24874478; PMCID: PMC4090740.
25. Lepik KV, Markelov VV. The Role of the Tumor Microenvironment in T-Cell Redirecting Therapies of Large B-Cell Lymphoma: Lessons Learned from CAR-T to Bispecific Antibodies. Cancers (Basel). 2025 Jan 20;17(2):317. doi: 10.3390/cancers17020317. PMID: 39858099; PMCID: PMC11763497.
26. Pasvolsky O, Bassett RL, Ghanem S, Cuglievan B, Tewari P, et al. Characteristics and outcomes of children, adolescents and young adults with relapsed/refractory non-hodgkin lymphoma undergoing autologous stem cell transplant. BMC Cancer. 2023;23(1):1258.
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| Issue | Vol 17 No 1 (2025) | |
| Section | Original Articles | |
| Keywords | ||
| Lymphoma Recurrence Risk Factors Stem Cell Transplantation | ||
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How to Cite
1.
Sharifi M, Gholamshahi M, Dormiani Tabatabaei SA, Tooyserkani SH, Akhoondi A. Factors Associated with Lymphoma Recurrence Following Autologous Stem Cell Transplantation; Data from Isfahan Cancer Center. Basic Clin Cancer Res. 2026;17(1):241-251.
