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Early Lymphocyte Recovery Predicts Superior Survival after Autologous Hematopoietic Stem Cell Transplantation for Patients with Primary Systemic Amyloidosis

Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota

Requests for reprints: Luis F. Porrata, Department of Hematology and Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905. Phone: 507-284-3158; Fax: 507-266-4972; E-mail: porrata.luis{at}mayo.edu.

Purpose: Absolute lymphocyte count recovery at day 15 (ALC-15) post-autologous stem cell transplantation (ASCT) is a powerful prognostic indicator for survival for multiple hematologic malignancies and metastatic breast cancer. The relationship of ALC-15 with clinical outcomes in primary systemic amyloidosis is unknown.

Experimental Design: We evaluated 145 consecutive patients with primary systemic amyloidosis who underwent ASCT at the Mayo Clinic from 1996 to 2003. The ALC-15 threshold was set at 500 cells/µL based on our previous observations.

Results: The median patient follow-up was 22 months (range, 3-87 months). Higher hematologic complete response was observed in patients with an ALC-15 500 cells/µL compared with patients with an ALC-15 < 500 cells/µL (41% versus 21%, P < 0.0008, respectively). The median overall survival and progression-free survival times were significantly better for the 59 patients that achieved an ALC-15 500 cells/µL compared with 86 patients with ALC-15 < 500 cells/µL (not reached versus 53 months, P < 0.0003 and not reached versus 27 months, P < 0.0001, respectively). Multivariate analysis showed ALC-15 to be an independent prognostic factor for overall survival and progression-free survival.

Conclusions: ALC-15 500 cells/µL is associated with significantly improved clinical outcomes following ASCT in patients with primary systemic amyloidosis.

Key Words: absolute lymphocyte count • autologous stem cell transplantation • primary systemic amyloidosis