CD34+ Cell Mobilization, Autograft Cellular Composition and Outcome in Mantle Cell Lymphoma Patients

Antti Samuli Turunen; Outi Kuittinen; Hanne Kuitunen; Kaija Vasala; Karri Penttilä; Minna Harmanen; Leena Keskinen; Pentti Mäntymaa; Jukka Pelkonen; Ville Varmavuo; Esa Jantunen; Anu Partanen

doi:10.1159/000531799

CD34⁺ Cell Mobilization, Autograft Cellular Composition and Outcome in Mantle Cell Lymphoma Patients

Transfus Med Hemother. 2023 Aug 23;50(5):428-437. doi: 10.1159/000531799. eCollection 2023 Oct.

Authors

Antti Samuli Turunen¹, Outi Kuittinen^{2

3

4}, Hanne Kuitunen⁴, Kaija Vasala⁵, Karri Penttilä^{6

7}, Minna Harmanen², Leena Keskinen⁸, Pentti Mäntymaa⁹, Jukka Pelkonen^{9

10}, Ville Varmavuo¹¹, Esa Jantunen^{1

2

12}, Anu Partanen¹

Affiliations

¹ Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
² Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
³ Department of Oncology, Kuopio University Hospital, Kuopio, Finland.
⁴ Cancer Centre, Oulu University Hospital, Oulu, Finland.
⁵ Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland.
⁶ Department of Medicine, Savonlinna Central Hospital, Savonlinna, Finland.
⁷ Finnish Medicines Agency, Kuopio, Finland.
⁸ Department of Oncology, Tampere University Hospital, Tampere, Finland.
⁹ Laboratory Centre of Eastern Finland, Kuopio, Finland.
¹⁰ Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland.
¹¹ Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland.
¹² Department of Medicine, North Carelia Hospital District, Joensuu, Finland.

Abstract

Backgound: Autologous stem cell transplantation (ASCT) is a standard treatment in transplant-eligible mantle cell lymphoma (MCL) patients after first-line chemoimmunotherapy.

Study design and methods: This prospective multicenter study evaluated the impact of CD34⁺ cell mobilization and graft cellular composition analyzed by flow cytometry on hematologic recovery and outcome in 42 MCL patients.

Results: During CD34⁺ cell mobilization, a higher blood CD34⁺ cell count (>30 × 10⁶/L) was associated with improved overall survival (median not reached [NR] vs. 57 months, p = 0.04). The use of plerixafor did not impact outcome. Higher number of viable cryopreserved graft CD34⁺ cells (>3.0 × 10⁶/kg) was associated with faster platelet (median 11 vs. 15 days, p = 0.03) and neutrophil (median 9 vs. 10 days, p = 0.02) recovery posttransplant. Very low graft CD3⁺CD8⁺ cell count (≤10 × 10⁶/kg) correlated with worse progression-free survival (PFS) (HR 4.136, 95% CI 1.547-11.059, p = 0.005). On the other hand, higher absolute lymphocyte count >2.5 × 10⁹/L at 30 days after ASCT (ALC-30) was linked with better PFS (median NR vs. 99 months, p = 0.045) and overall survival (median NR in either group, p = 0.05).

Conclusions: Better mobilization capacity and higher graft CD3⁺CD8⁺ cell count had a positive prognostic impact in this study, in addition to earlier lymphocyte recovery (ALC-30>2.5 × 10⁶/L). These results need to be validated in another study with a larger patient cohort.

Keywords: Autologous; CD34+ cells; CD4+CD8+ cells; Graft composition; Lymphocytes; Mantle cell lymphoma; Mobilization; Transplantation.

Grants and funding

The GOA study was financially supported by grants from North Savo Hospital District EVO and VTR Funds. The GOA study also received a study grant from Sanofi. Dr. Turunen is grateful for the grants provided by North Savo Hospital District Research Fund, the Finnish Blood Disease Research Foundation, the Finnish Medical Foundation, the Finnish Society of Hematology, and the Signe and Ane Gyllenberg Foundation. The funders had no role in study design, data collection, data analysis, interpretation of the results, or manuscript writing process.