Autologous Stem Cell Transplantation for Refractory or Poor-Risk Relapsed Hodgkin's Lymphoma: Effect of the Specific High-Dose Chemotherapy Regimen on Outcome

Abstract

More active high-dose chemotherapy (HDC) regimens are needed for refractory Hodgkin's lymphoma (HL). We report a cohort analysis of 180 consecutive patients with primary refractory or poor-risk relapsed HL treated with busulfan-melphalan (Bu-Mel) (n = 39), gemcitabine-busulfan-melphalan (Gem-Bu-Mel) (n = 84), or BEAM (BCNU, etoposide, ara-C, melphalan; n = 57) between 2005 and 2010. Their pre-HDC positron emission tomography (PET) scans were interpreted prospectively. Despite more prevalent poor-risk features in the Gem-Bu-Mel cohort, such as PET-positive tumors at HDC, tumors growing at HDC, extranodal disease, or bulky tumors at prior relapse, this cohort had improved outcomes compared with the Bu-Mel and BEAM cohorts, with event-free survival (EFS) rates of 57%, 33%, and 39%, respectively (P = .01), at median follow-up of the whole population of 36 months (range, 3 to 72). Their respective overall survival (OS) rates were, respectively, 82%, 52%, and 59% (P = .04). Secondary acute myelogenous leukemia was seen in 5 patients after BEAM but was not seen in Gem-Bu-Mel and Bu-Mel cohorts (P = .004). Multivariate analyses showed independent adverse effects of an HDC regimen different from Gem-Bu-Mel (hazard ratio [HR] for EFS = 2.3, P = .0008; HR for OS = 2.7, P = .0005), positive PET at HDC (HR for EFS 2.2, P = .004, HR for OS = 3.1, P = .0001), and >1 previous salvage line (HR for EFS = 1.9, P = .008, HR for OS = 1.8, P = .07). Gem-Bu-Mel improved outcomes in this cohort analysis of patients with refractory/poor-risk relapsed HL and merits evaluation in randomized phase III trials.

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

“…32 The Houston team showed independent adverse effect (Hazard ratio 3.1) of positive PET at transplant in 180 poor-risk relapsing or refractory HL patients. 51 Devillier et al also recently reported in 111 patients with relapsed or refractory HL that only PET status significantly influenced OS in multivariate analysis, regardless of disease risk at relapse. 52 On the other hand, the same studies emphasize that a substantial proportion of patients with positive PET before HDT will remain free of subsequent relapse, indicating that some patients could be cured despite a hypermetabolic residual mass after salvage therapy, but also that interpretation criteria could probably be improved to maximize FDG-PET positive predictive value in this setting.…”

Carmustine replacement in intensive chemotherapy preceding reinjection of autologous HSCs in Hodgkin and non-Hodgkin lymphoma: a review

“…Toxicity seemed equivalent between regimens; however, there were better survival results with GemBuM. 86 …”

Új lehetőségek a refrakter és relabált Hodgkin-lymphomás betegek kezelésében

“…A BEAM-nál hatékonyabb és kevésbé toxikus busulfanalapú kondicionáló kezelést keresve Nieto és mtsai a busulfan-melphalan, a gemcitabin-busulfanmelphalan és a BEAM-kezelések hatékonyságát hasonlí-tották össze. A leghatékonyabbnak a gemcitabin-busulfan-melphalan bizonyult, az eseménymentes túlélés (EFS) 87%, a teljes túlélés (OS) pedig 82% volt [17]. Történtek vizsgálatok a carmustin helyett nagy dózisú bendamustin, fotemustin alkalmazásával, de a kis betegszám (15, illetve 20 HL-beteg) miatt még nem értékel-hetőek egyértelműen [18,19].…”