Non-cryopreserved Autologous Peripheral Blood Stem Cell Transplantation for Lymphoma in a Resource-Limited Setting:...

Background  Autologous stem cell transplantation (ASCT) is a standard consolidation strategy for selected patients with relapsed or high-risk lymphoma, but access remains limited in many low- and middle-income regions because of the cost and infrastructure required for stem cell cryopreservation. Non-cryopreserved ASCT using fresh peripheral blood stem cells stored at 4°C may provide a practical alternative. Methods  We retrospectively analyzed 11 consecutive patients with lymphoma who underwent non-cryopreserved ASCT at the Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar. Peripheral blood stem cells were mobilized with granulocyte colony-stimulating factor (G-CSF) alone or G-CSF plus plerixafor, stored at 4°C, and infused after institutional modified BEAM conditioning. Primary endpoints were feasibility, CD34+ cell collection, neutrophil and platelet engraftment, early toxicities, and day +100 survival. Results  The median age was 41 years (range, 22-58), and 9 patients (81.8%) were male. Diagnoses included classical Hodgkin lymphoma in 4 patients (36.4%) and non-Hodgkin lymphoma in 7 patients (63.6%). Stage III-IV disease was present in 8 patients (72.7%), and 9 patients (81.8%) were in complete remission before transplant. G-CSF plus plerixafor was used in 9 patients (81.8%). The median CD34+ cell dose collected was 5.5 × 10^6/kg (range, 3.6-13.5), with a median of 2 apheresis sessions (range, 1-2). All grafts were stored for 6 days at 4°C. Median neutrophil and platelet engraftment occurred on day 11 (range, 10-13) and day 12 (range, 10-18), respectively. Febrile neutropenia occurred in 10 patients (90.9%); grade 3-4 mucositis occurred in 6 patients (54.5%). Day +30 survival was 100%, and day +100 survival was 90.9%, with one transplant-related death. Conclusion Non-cryopreserved ASCT for lymphoma was feasible at SKIMS Srinagar, with adequate CD34+ cell collection, rapid engraftment, and acceptable early survival. Larger prospective studies with standardized graft-quality monitoring, longer follow-up, and cost-effectiveness analysis are needed.