Autologous stem cell transplant for early relapsed/refractory Hodgkin lymphoma: results from two transplant centres

Abstract

SummaryPrior series have demonstrated that early relapsed (within 1 year) or refractory Hodgkin lymphoma (HL) is associated with poor prognosis. To determine the outcome for patients with early relapsed/refractory HL in the modern era, we combined data from two large transplant centres, Cleveland Clinic Taussig Cancer Institute (CCTCI) and Memorial Sloan-Kettering Cancer Center (MSKCC), and analysed consecutive patients transplanted for relapsed/refractory HL following induction failure or remission durations of <1 year. Two hundred and fourteen patients were analysed and the event-free survival (EFS) and overall survival (OS) at 6 years for all patients were 45% and 55%, respectively. Factors significant for prognosis in multivariate analysis were extranodal disease and bulky disease ( ‡5 cm). Patients with 0, 1, or 2 risk factors achieved 6 year EFS of 65%, 47%, and 24% and 6 year OS of 81%, 55%, and 27%, respectively. Patients with the sole risk factor of early relapsed/refractory disease achieved good outcomes in this large series; however the presence of bulk and/or extranodal disease significantly reduced EFS and OS. Patients with these additional risk factors are best suited for clinical trials investigating novel salvage regimens and post-transplant maintenance strategies.

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

“…With this strategy, the cure rate can be estimated at 50-60%. 15 With the aim of improving these results, the expert panel of the HL committee of the LYSA recommends a strategy including: 1) dose-adaptation according to pre-transplant patient's characteristics; 2) dynamic adjustment of salvage chemotherapy according to results of interim response evaluation; and 3) as far as possible, restriction of HDT to patients who are demonstrated as chemosensitive. Three major prognostic factors at relapse (refractoriness, short disease-free interval and disseminated disease) that allow stratification of patients into three meaningful risk groups have been retained by the panel.…”

“…There have been inconsistent reports of other predictive risk factors, sometimes with independent value, such as anemia, poor performance status (PS), presence of B symptoms, extranodal relapse, relapse in previous radiation field, age, or bulky disease, but the latter were not retained by the expert panel to serve in the risk group definition. 2,14,15 Primary refractoriness is defined either by progression at any time during chemotherapy or radiotherapy (RT) and up to three months after the end of treatment, and/or by persistence of a PET positive residual mass, using the quantitative 5-point scale Deauville score (DS) for PET interpretation. Using these criteria, a positive FDG-PET (i.e.…”

“…Tandem transplantation has been performed in a subset of patients at other institutions. 15 Based on the above-mentioned data, the opinion of the expert committee is that outcome of high-risk patients is unacceptably low and that these patients should be targeted with more intensive approaches, i.e. tandem transplantation, provided that they display chemosensitivity after salvage chemotherapy.…”

Cost‐effectiveness analysis of consolidation with brentuximab vedotin for high‐risk Hodgkin lymphoma after autologous stem cell transplantation

“…5–10, 40 As an anti-CD30 antibody-drug conjugate, BV has clear efficacy as a single-agent in the relapsed HL setting, including the potential for long-term durable remissions in a small subset of individuals. 13, 14 With efficacy clearly established in relapsed and refractory HL, investigations testing BV in the first-line setting are underway.…”

Evolving Therapies in Relapsed and Refractory Hodgkin Lymphoma

“…There are several proposed risk factors to identify patients at high risk to develop disease progression following HDC-ASCT such as chemotherapy resistant disease prior to HDC-ASCT, B symptoms at the time of relapse, residual disease at the time of transplantation by functional imaging, extra-nodal disease at the time of relapse, and bulky disease. 98,99 Patients with any of these high risk factors may be suited for alternative therapeutic strategies such as tandem transplant, allogeneic bone marrow transplant, and/or post-HDC-ASCT maintenance therapy in the context of a clinical trial.…”