Poster: ABCL-378: Prolonged Cytopenias in Autologous Stem Cell Transplantation in Relapsed/Refractory Diffuse Large B-Cell Lymphoma

Context While patients with relapsed non-Hodgkin Lymphoma (NHL) can be cured with autologous hematopoietic cell transplant (ASCT), many require management of post-ASCT cytopenias for extended time. The impact of this complication on post-ASCT survival outcomes is not well known. Objective We evaluated whether absolute neutrophil count (ANC) and platelet count (PC) at day 100 post-ASCT were predictors of progression-free survival (PFS) or overall survival (OS) in patients with relapsed NHL. Design This was a retrospective cohort study evaluating patients with relapsed/refractory NHL who received ASCT between 2013–2019. Setting Patients in this study underwent ASCT at Emory University Hospital and were followed at our center for a period after ASCT with laboratory and imaging studies. Patients or Other Participants We included patients initially diagnosed with NHL who subsequently relapsed and received ASCT for an aggressive NHL subtype. Patients who received chimeric antigen receptor T-cell (CART) therapy prior to ASCT, as well as patients who relapsed after ASCT and received treatment prior to day 100, were excluded. Groups were divided based on ANC and PC at day 100, using cutoffs of 1000 and 50,000 respectively. We analyzed 156 patients, including 142 (91.0%) with diffuse large B-cell lymphoma (DLBCL). Within this group, 13 (8.3%) had platelet counts < 50,000, and 27 (17.3%) had ANC < than 1000. Interventions None. Main Outcomes Measures Our primary study outcomes measurements were OS and PFS. We hypothesized that patients with PC < 50,000 and ANC < 1000 would have worse OS and PFS than those without prolonged cytopenias. This hypothesis was formulated prior to data collection. Results Groups were similar across gender, race, induction, and conditioning regimen. However, there was a significantly greater percentage of patients in the PC < 50,000 and ANC < 1000 groups that had bone marrow involvement (PC: p=0.013; ANC: p=0.002). Patients with PC > 50,000 had an improved OS in both univariate analysis (p=0.002; HR 0.26 [0.11–0.62]) and multivariable analysis (p=0.003; HR 0.28 [0.12–0.66]) but did not significantly impact PFS, while ANC was not statistically associated with PFS or OS. Conclusions Our analysis showed that in patients with relapsed/refractory NHL, a PC > 50000 at day 100 was an independent predictor of OS but not PFS, whereas ANC > 1000 did not predict OS or PFS. While patients with relapsed non-Hodgkin Lymphoma (NHL) can be cured with autologous hematopoietic cell transplant (ASCT), many require management of post-ASCT cytopenias for extended time. The impact of this complication on post-ASCT survival outcomes is not well known. We evaluated whether absolute neutrophil count (ANC) and platelet count (PC) at day 100 post-ASCT were predictors of progression-free survival (PFS) or overall survival (OS) in patients with relapsed NHL. This was a retrospective cohort study evaluating patients with relapsed/refractory NHL who received ASCT between 2013–2019. Patients in this study underwent ASCT at Emory University Hospital and were followed at our center for a period after ASCT with laboratory and imaging studies. We included patients initially diagnosed with NHL who subsequently relapsed and received ASCT for an aggressive NHL subtype. Patients who received chimeric antigen receptor T-cell (CART) therapy prior to ASCT, as well as patients who relapsed after ASCT and received treatment prior to day 100, were excluded. Groups were divided based on ANC and PC at day 100, using cutoffs of 1000 and 50,000 respectively. We analyzed 156 patients, including 142 (91.0%) with diffuse large B-cell lymphoma (DLBCL). Within this group, 13 (8.3%) had platelet counts < 50,000, and 27 (17.3%) had ANC < than 1000. None. Our primary study outcomes measurements were OS and PFS. We hypothesized that patients with PC < 50,000 and ANC < 1000 would have worse OS and PFS than those without prolonged cytopenias. This hypothesis was formulated prior to data collection. Groups were similar across gender, race, induction, and conditioning regimen. However, there was a significantly greater percentage of patients in the PC < 50,000 and ANC < 1000 groups that had bone marrow involvement (PC: p=0.013; ANC: p=0.002). Patients with PC > 50,000 had an improved OS in both univariate analysis (p=0.002; HR 0.26 [0.11–0.62]) and multivariable analysis (p=0.003; HR 0.28 [0.12–0.66]) but did not significantly impact PFS, while ANC was not statistically associated with PFS or OS. Our analysis showed that in patients with relapsed/refractory NHL, a PC > 50000 at day 100 was an independent predictor of OS but not PFS, whereas ANC > 1000 did not predict OS or PFS.