High-dose chemotherapy followed by autologous stem cell transplantation for relapsed or refractory Hodgkin lymphoma: Prognostic features and outcomes

Abstract

Between January 1990 and April 2001, 115 patients received high-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) for relapsed or refractory Hodgkin lymphoma (HL). With a median follow-up of 58 months (range, 1 - 175 months), 5-year progression-free survival (PFS) and overall survival (OS) were 46% and 58%, respectively. Twelve patients with primary refractory disease had a 5-year PFS of 41% and OS of 58%, not significantly different from those of the remaining cohort. Early and overall regimen related mortality were 7% and 16%, respectively. Male gender (P = 0.04) and a time to relapse (TTR) < 12 months (P = 0.03) were associated with decreased OS by univariate analysis. In multivariate analysis, TTR < 12 months remained statistically significant (P = 0.04). We have confirmed that HDT and ASCT result in long-term survival for a proportion of patients with relapsed or refractory HL. All patients, including those with primary refractory disease, benefited from HDT and ASCT.

High-Dose Therapy and Autologous Hematopoietic Progenitor Cells Transplantation for Recurrent or Refractory Hodgkin's Lymphoma: Analysis of King Hussein Cancer Center Results and Prognostic Variables

“…This is consistent with some previously published studies [15–19], although this was not shown in the study published by Engelhardt et al [21]. In our study there was a trend towards improvement in RFS in patients who received two lines of chemotherapy in comparison to those who received more than two lines, but this was not statistically significant, probably due to the small sample size.…”

“…The disease status at the time of transplant (CR versus RD) did not affect the OS or RFS, and this is consistent with Engelhardt et al study [21], but contradicting other studies [14, 17, 20]. We believe that the main reason for this is the small sample size in our study, as there was a trend towards improvement in patients who were in CR over those who had RD, with P values of 0.10 and 0.15 for RFS and OS, respectively.…”

“…One of these factors is the number of chemotherapy lines patients received prior to transplant [15–19]. Another factor which was shown in previous studies to predict the risk of relapse was the disease status at the time of transplant, with superior outcomes in patients who were in complete remission (CR), or minimal residual disease in comparison to those with bulky disease [14, 17, 20], and the last factor which was shown to influence the outcome is the time to initial relapse (TTR) >12 months versus <12 months which is measured from the date of diagnosis to that of proven relapse [21]. At the King Hussein Cancer Center (KHCC) bone marrow and stem cell transplantation program, Amman, Jordan, we performed stem cell transplantation for 63 patients with HL between the years 2003 and 2008.…”

Role of Cytotoxic Therapy with Hematopoietic Cell Transplantation in the Treatment of Hodgkin Lymphoma: Guidelines from the American Society for Blood and Marrow Transplantation

“…In the studies reported, we have included risk factors that were associated with inferior outcome in at least 2 studies. The following adverse factors were identified as useful at time of relapse: anemia (hemoglobin < 10 g/dL), stage (III/IV), remission duration < 12 months, B symptoms, extranodal sites of disease, and bulky disease at diagnosis [20][21][22]24,25,31,40,41,59,61,62,64,81,[134][135][136][137][138][139][140][141][142]. Short remission duration is the factor most consistent across different series.…”