Retrospective Study Assessing Outcomes of AYA Patients with Lymphoma Following Auto Stem Cell Transplant

Introduction Hematopoietic stem cell transplantation (HSCT) offers a potential curative option and can prolong overall survival (OS) for many patients with Hodgkin and non-Hodgkin Lymphomas (NHL). Lymphomas in the adolescent and young adult (AYA) population have had minimal improvement in lymphoma-specific survival rates over the years, especially when compared to pediatric and older populations. AYAs also are at increased risk for treatment/disease related late effects given the likelihood of longer life spans following treatment. We aimed to further investigate outcomes for AYA patients with lymphoma who have received auto-HSCT and compared them to outcomes of older patients. Methods This was a single-center, retrospective chart review study from the Fox Chase-Temple University Hospital Bone Marrow Transplant Program; with the data being obtained from the Bone Marrow Transplant Program's internal database and confirmed by electronic medical record. Chi square and Anova test were used for statistical analysis. Results From 2014-2021, 253 lymphoma patients received an auto-HSCT for Lymphoma at our facility. Baseline characteristics are detailed in Table 1. The AYA population had a higher percentage of Hodgkin diagnoses with the older 2 groups having increased proportion of aggressive NHLs. There was no difference in length of hospital stay across groups. The duration of follow up with the Fox Chase BMT team (and the amount of data available for follow up analysis) was similar across all groups. The difference in 3 year and 5 year OS was statistically significant across the 3 groups, with the AYA group having the best OS (p-value .007/.001 respectively), while PFS at 3 and 5 years was similar across the 3 groups. The 5 year OS of the AYA population, the 40-60 age group, and the 60+ group were 76%, 64%, and 41% respectively (Figure 1). Regarding long term adverse effects, AYA patients had less incidence of secondary myeloid/non myeloid malignancies compared to the older populations (Figure 2). There was limited data on rates of depression/anxiety, but at least 9 of the 35 patients in the AYA group were noted to have worsening psychiatric complaints in the post-transplant period (Figure 3). Conclusion Our study revealed that AYA patients with Lymphoma who undergo HSCT have excellent survival and relatively few secondary malignancies following transplant within 5 year follow up. Their follow up rates with the BMT clinic were similar to the non AYA population suggestive of equivalent compliance. Notably, the AYA patients appear to have a higher risk of social and emotional distress in the post transplant setting regardless of disease status.