Autologous stem cell transplantation for primary refractory Hodgkin’s disease: results and clinical variables affecting outcome

Constans, Mireia; Sureda, Anna; Terol, María José; Arranz, Reyes; Caballero, Marı́a Dolores; Iriondo, A; Jarque, Isidro; Carreras, Enric; Moraleda, José M.; Carrera, Dolores; León, Ángel; López, Andrés; Albó, Carmen; Dı́az-Mediavilla, Joaquı́n; Fernández-Abellán, Pascual; García‐Ruiz, Juan Carlos; Hernández-Navarro, Fernando; Mataix, R; Petit, J; Pascual, María José; Rifón, J.; Garcı́a-Conde, J; Fernández-Rañada, J M; Mateos, M. V.; Sierra, Jorge; Conde, Eulogio

doi:10.1093/annonc/mdg206

Cited by 39 publications

(21 citation statements)

References 20 publications

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“…The outcome of HDC group seems better than that usually reported. The actuarial OS for 70 patients treated with HDC was 43% in the German group, 18 50% at 3 years in a group of 122 HL patients reported by Lazarus et al, 31 about 25% at 5 years in the GEL/TAMO Cooperative Group study 22 and, finally, in the EBMT study dealing with 175 patients with primary induction failure, the actuarial 5-year OS was 36%; however, patients transplanted without further attempts to induce remission with CC had a longer OS comparing with patients who were transplanted after failing to respond to a second-line treatment. 23 Furthermore, Andreè t al.…”

Section: Discussionmentioning

confidence: 83%

“…However, several encouraging reports suggest that HDC can improve outcome in patients with primary refractory HL. [18][19][20][21][22] Current clinical trials in HL are seeking to define the amounts of treatment that produce the optimum therapeutic results. Currently, the three-level scheme of division into early favourable, early unfavourable and advanced disease cases remains a suitable instrument for tailoring riskadapted therapy.…”

Section: Discussionmentioning

confidence: 99%

“…21 None of them were in CR at the time of transplantation. Overall, literature data demonstrated that the HDC strategy is able to generate a reliable rate (29-58%) of complete responders in primary refrac- High-dose therapy in refractory Hodgkin's lymphoma F Morabito et al tory HL; [22][23][24][25][26][27][28][29][30][31] however, it cannot be stated that this approach is definitively superior to conventional-dose salvage therapy. Notably, the achievement of a CR with a potentially curative treatment guaranteed prolonged survival in patients belonging to our series, regardless of the therapeutic approach.…”

Section: Discussionmentioning

confidence: 99%

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The role of high-dose therapy and autologous stem cell transplantation in patients with primary refractory Hodgkin's lymphoma: a report from the Gruppo Italiano per lo Studio dei Linfomi (GISL)

Morabito

Stelitano

Luminari

et al. 2005

Bone Marrow Transplant

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GISL recently conducted an exhaustive survey of 1078 patients with Hodgkin's Lymphoma (HL) enrolled between 1988 and 2002 in different prospective trials. Treatment failure was observed in 82 out of 1078 patients; of these 82 patients with refractory HL, complete information was available for 72, who form the evaluable population of the present study. After the initial therapy failure, 51 patients were treated with conventional salvage chemotherapy ( CC) (n = 24) or high-dose chemotherapy (HDC) (n = 27); 4-year overall survival ( OS) was 81% in the HDC group versus 38% in the CC group ( P = 0.019). The remaining 21 patients had rapidly progressive disease and died. After a median follow-up of 2.8 years, the projected OS for all 72 patients is 58 and 49% at 3 and 5 years, respectively. Age <45 years, the absence of systemic symptoms and a PS <1 predicted a significantly longer OS. Interestingly, the majority of patients with two or three negative prognostic factors did not receive potentially curative therapy. In conclusion, HDC seems to be a reasonable option for selected patients with refractory HL, although the majority of them did not receive a transplant. Finally, patients with a high-risk score had little chance of receiving potentially curative treatment

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The role of high-dose therapy and autologous stem cell transplantation in patients with primary refractory Hodgkin's lymphoma: a report from the Gruppo Italiano per lo Studio dei Linfomi (GISL)

Morabito

Stelitano

Luminari

et al. 2005

Bone Marrow Transplant

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“…Multiple single-arm studies incorporating both relapsed and refractory HL patients have demonstrated that a salvage approach incorporating HDCT/ ASCT results in durable PFS and OS rates in the range of 40%-50% and 50%-60%, respectively [3,6,[23][24][25][26]. Importantly, patients with refractory disease generally do worse, with durable PFS and OS rates in the range of 15%-32% and 26%-36%, respectively [7,8,23,27,28].…”

Section: Evidence For Hdct/asct and Likelihood Of Successmentioning

confidence: 99%

Salvage Therapy in Hodgkin’s Lymphoma

Mendler

Friedberg

2009

The Oncologist

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1. Appraise the most important properties of a salvage chemotherapy regimen and name at least three effective regimens.2. Evaluate poor-risk clinical features pre-HDCT/ASCT that reduce the chance for cure and design a more effective alternative transplant approach.3. Hypothesize the reasons for the effectiveness of monoclonal antibodies that have shown activity against relapsed HL.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTHodgkin's lymphoma (HL) is a commonly cured malignancy. Unfortunately, patients who are refractory to or relapse after first-line treatment pose a significant therapeutic challenge. There is evidence that these patients are best treated with an approach involving salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant (HDCT/ASCT). This approach may result in cure, with better results in patients with low-risk relapse. In patients with high-risk relapse and refractory disease, HDCT/ASCT is rarely curative. More aggressive transplant approaches have shown promising results in this group and are currently under active investigation. For those relapsing after HDCT/ASCT, there exists a range of therapeutic options, including further salvage chemotherapy, reduced-intensity allogeneic transplantation, monoclonal antibody therapy, and novel agents. All patients in this category should be considered for enrollment in clinical trials. This review discusses the evidence behind the current practice in patients with relapsed or refractory HL. Specifically, the efficacy of various salvage chemotherapy regimens, the risk factors influencing outcome with HDCT/ASCT, and the results with alternative transplant approaches, monoclonal antibody therapies, and novel agents are addressed. We conclude by providing our approach to these patients, with the hope that this will serve as a framework for the practicing oncologist.

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“…Hodgkin's lymphoma, almost uniquely among human neoplasms, can be cured with the use of HDC/HSCT even when the disease does not respond to standard dose chemotherapy. 45 Although a variety of HDC regimens have been described, no one regimen has been shown to be clearly superior. Currently, popular regimens include CBV (cyclophosphamide, carmustine [BCNU] 17,19,25,50 or high-dose melphalan with or without total body irradiation.…”

Section: Technique Of Hdc/hsctmentioning

confidence: 99%

Hodgkin’s Lymphoma: Biology and Treatment Strategies for Primary, Refractory, and Relapsed Disease

Diehl¹,

Stein²,

Hummel³

et al. 2003

Hematology

145

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Hodgkin's lymphomas belong to the most curable tumor diseases in adults. About 80% of patients in all anatomical stages and of all histological subtypes can be cured with modern treatment strategies. In spite of the great clinical progress, the pathogenesis of this peculiar lymphoproliferative entity has not been elucidated completely up until now.In In Section III, Dr. Connors states that fortunately there is a considerably decreased need for salvage strategies in Hodgkin's lymphomas since primary treatment results in a more than 80% tumor control. Nevertheless, a significant number of patients experience either a tumor refractory to therapy or an early or late relapse. Therefore, one of the continuing challenges in the care for Hodgkin's lymphomas today is to find effective modes for a second tumor control. High-dose chemotherapy followed by autologous stem cell support has proved to be the treatment of choice when disseminated tumors recur after primary chemo-and or radiotherapy. Nodal relapses respond well to local radiation when they recur outfield of primary radiation without B-symptoms and in stages I-II at relapse. Allogeneic stem cell support needs further intensive evaluation in controlled studies to become an established alternative.

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Autologous stem cell transplantation for primary refractory Hodgkin’s disease: results and clinical variables affecting outcome

Abstract: In our experience, although overall results of ASCT in PR-HD patients are poor, one-quarter of the patients remain alive at 5 years. Despite this, other therapeutic strategies should be investigated in this group of patients to improve the outcome.

Cited by 39 publications

References 20 publications

The role of high-dose therapy and autologous stem cell transplantation in patients with primary refractory Hodgkin's lymphoma: a report from the Gruppo Italiano per lo Studio dei Linfomi (GISL)

The role of high-dose therapy and autologous stem cell transplantation in patients with primary refractory Hodgkin's lymphoma: a report from the Gruppo Italiano per lo Studio dei Linfomi (GISL)

Salvage Therapy in Hodgkin’s Lymphoma

Hodgkin’s Lymphoma: Biology and Treatment Strategies for Primary, Refractory, and Relapsed Disease

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