Can immune profiling help predict outcomes for patients with NHL after a stem cell transplant?

This study compared the outcomes of filgrastim (Neupogen) treatment with versus without plerixafor (Mozobil) in patients with B-cell non-Hodgkin's lymphoma (NHL) after a stem cell transplant. The authors concluded that certain immune cell biomarkers were associated with poorer long-term survival for these patients.

Autologous stem cell transplantation (ASCT) is often used to treat patients with B-cell NHL. Before the transplant, healthy stem cells are collected from the patient's bloodstream. This is called mobilization. Chemotherapy is then given to get rid of any remaining cancer cells. Then, the collected healthy cells are given back to the patient to help the body produce new healthy blood cells.

Some patients need treatments to help increase their stem cell production. Plerixafor and filgrastim are two such treatments. Previous studies have suggested that the new immune cells made with plerixafor may be different from cells made with the help of filgrastim. With immune profiling, these differences may lead to different outcomes for patients after the transplant. Whether mobilization with plerixafor and filgrastim together is more effective than filgrastim alone for patients with NHL is unclear.

This study had 104 adults with NHL who underwent ASCT. More than half (58%) of the patients had diffuse large B-cell lymphoma (DLBCL), and 42% had mantle cell lymphoma (MCL). Two types of T cells (immune cells that help fight infection) were measured before and after the transplant. These included CD4 cells and CD8 cells. Patients were followed up for an average of 61 months.

Before the transplant, 77% of patients with MCL had no signs of cancer. However, 40% of patients with DLBCL had the cancer come back or stop responding to treatment after chemotherapy. After the transplant, 91% of all patients were still alive with no signs of cancer.

CD8 and CD4 cell counts were measured before and after the transplant. There was no significant difference in survival between patients who had higher cell counts (above 75%) compared to patients who had lower cell counts (75% or less). 

However, having more CD8 cells than CD4 cells (a high CD8:CD4 ratio) was significantly associated with poorer survival. Significantly more patients who had a lower ratio of these cells 100 days after the transplant were still alive compared to patients who had higher ratios.

This study concluded that certain immune cell counts were associated with poorer long-term outcomes for patients with NHL after ASCT. The authors suggest that identifying patients with more CD8 cells than CD4 cells can help adapt treatment approaches.

This was a small study. More studies with larger patient populations are needed to confirm these results. The value of CD8 and CD4 cell counts in predicting patient outcomes after ASCT needs further investigation.

Talk to your care team about the possible benefits of immune profiling before and after ASCT.