Morbidity, Mortality and Normality after Autologous Stem-Cell Transplantation for Lymphoma: A Comprehensive, Single-Centre, Population-Based, Real-World Analysis of Patients Transplanted 1994-2016

Background: Autologous stem-cell transplantation (ASCT) is established lymphoma therapy, but the procedure has a substantial treatment-related mortality. Methods All 433 lymphoma patients who underwent ASCT at Karolinska Huddinge 1994-2016 were investigated, including long- and short-term mortality, causes of death, longitudinal laboratory values and anti-lymphoma treatments, harvested and transplanted CD34 cell amounts, infectious and other complications, microbiology findings, intensive care, drugs administered, chemotherapy-induced nausea, hospital stay, and secondary myeloid neoplasia. Findings: BEAM was the conditioning for 93%. The 100-day overall and non-lymphoma mortality were 7·2% and 5·6%. Stem cell harvests <5 million CD34 cells/kg correlated with inferior long- and short-term survival. At start of conditioning, elevated (both 3-9 and ≥10 mg/L) C-reactive protein (CRP) and creatinine but low albumin predicted inferior 100-day non-lymphoma mortality. Higher age (65-72 years) had no bearing on 100-day mortality. Delays between the last dose of chemotherapy and ASCT did not correlate with inferior outcome. Intravenous antibiotics was given to 97% (22% positive blood cultures) and parenteral nutrition to 86%. Fungal infections were rare. Aprepitant ameliorated nausea and vomiting. The median days for leukocyte engraftment and hospital discharge were 11 and 16. At one year, 86% and 76% had normalised haemoglobin and platelets. The cumulative five-year risk for secondary myeloid neoplasia was 4·1%, associated with smaller stem cell harvests. Interpretation: In ASCT for lymphoma, the harvest should be ≥5 million CD34 cells/kg. Before starting conditioning, patients should preferably show normal CRP, albumin, and creatinine. It is safe to postpone the procedure, and to transplant older patients. Funding: Funded by Stockholm County Council (clinical research appointment), Cancerfonden, and Svenska Sallskapet for Medicinsk Forskning (SSMF). Role of the funding source: the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Declaration of interests: The authors have no conflict of interest. Ethics Approval Statement: This study was approved by the Ethics Committee, Stockholm.