In a nutshell
This study examined the use of lymphocyte and monocyte blood counts to predict the outcome of autologous stem cell (immature blood cell) transplantation in children and young adults. The study concluded that the lymphocyte/monocyte ratio can be used to predict a likely relapse following autologous stem cell transplantation.
Some background
Hodgkin lymphoma (HL) is generally considered a curable disease. However, some HL is difficult to treat (refractory) or comes back after treatment (relapse). For these patients, autologous stem cell transplantation (ASCT; transplant using patient’s own stem cells) is a common treatment option. Unfortunately, relapse after ASCT still occurs.
It is important to identify patients who may relapse after ASCT early so further treatment options can be explored. One method for doing this is through a blood test. This test looks at the ratio of lymphocytes and monocytes in the blood (type of white blood cells; ALC/AMC). The ALC/AMC ratio has been shown to predict relapse in adults. Further study is needed to determine its effectiveness in children and young adults.
Methods & findings
The medical records of 76 patients were reviewed. All patients were under the age of 26, and received an autologous stem cell transplantation because of relapsed or refractory HL. The average follow-up time for all patients was 3.86 years.
The study used a cut-off point of 1,060 lymphocytes per microliter and 760 monocytes per microliter. Fewer lymphocytes or monocytes (white blood cells) generally indicated a better response to treatment. An ALC/AMC ratio of 2.1 was the cut-off point determined to predict relapse.
Patients with a ratio below 2.1 had significantly better relapse free survival (time from ASCT to relapse; 93% at 4 years) compared to patients with a ratio of 2.1 or greater (33% at 4 years).
The 4-year overall survival (time from ASCT to death from any cause) was 96% for patients with a ratio below 2.1. The 4-year overall survival was 76% for patients with a ratio of 2.1 or higher. The overall survival was significantly better for patients with an ALC/AMC ratio below 2.1.
A PET scan that was positive for HL activity at 100 days following ASCT was also predictive of relapse.
The bottom line
The authors concluded that the ALC/AMC ratio is a good predictor of relapse in children and young adults who have received autologous stem cell transplantation to treat HL.
Published By :
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Date :
Apr 20, 2017
