High-dose therapy and autologous stem cell rescue for patients with Hodgkin’s disease in first relapse after chemotherapy: results from the EBMT

Abstract

Summary:The use of conventional-dose salvage chemotherapy in The purpose of this study was to investigate the results patients with Hodgkin's disease who relapse after initial of high-dose therapy and autologous stem cell transcombination chemotherapy is associated with high plantation in adult patients with Hodgkin's disease in remission rates, especially if the initial CR duration is first relapse after chemotherapy, to determine the overlonger than 1 year. 1-5 However, long-term follow-up studall and progression-free survival, identify prognostic ies have shown that less than 20% of these patients achieve factors for outcome, and to define the role of conventional dose salvage therapy given prior to the high dose long-term disease-free survival. 6 regimen. A retrospective analysis of 139 adult patients High-dose therapy, with autologous stem cell transplanreported to the lymphoma registry of the European tation (ASCT), has been used extensively in patients with Group for Blood and Marrow Transplantation (EBMT)relapsed Hodgkin's disease. [7][8][9][10][11][12][13][14] In early studies, its use was between February 1984 and July 1995 is considered.confined to patients who had failed multiple combination Data on all patients were reviewed and prognostic facchemotherapy regimens. Analysis of prognostic factors in tors determined in univariate analysis. The actuarial 5-these studies demonstrated that extensive prior therapy, year overall survival (OS) and progression-free survival short remission duration, resistance of disease to conven-(PFS) for the entire group of 139 patients were 49.4 and tional-dose chemotherapy and bulk disease at the time of 44.7%, respectively. In univariate analysis for OS, dis-ASCT were commonly identified adverse features. ease bulk at the time of high-dose therapy, second-line As a result of these findings, and of decision analyses regimen, initial remission duration and status at transregarding the use of high-dose therapy, 15 several groups plant had no predictive value. Status at transplant was have recently reported the use of high-dose therapy in predictive for OS when patients in second complete patients with Hodgkin's disease at the time of the first remission (CR) were analysed separately from those in relapse after chemotherapy. 10,13,14,16 These single institution chemosensitive relapse. Similar trends were observed studies have shown a favourable outcome for these patients for PFS. We concluded that high-dose therapy and autocompared with historical series of conventionally treated logous stem cell transplantation is an effective strategy patients, and have again identified prognostic factors for for patients with Hodgkin's disease in first relapse after long-term disease-free survival, including duration of initial chemotherapy. These results suggest that it should be remission, disease bulk at the time of ASCT, and sensitivity used regardless of initial remission duration. The role to conventional-dose therapy given prior to the high-dose of conventional-dose salvage give...

Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR)

“…Some of these subjects may not proceed to transplantation because of intercurrent medical problems associated with multiple attempts to induce remission. This inherent selection bias may explain, in part, the less favorable results in untested relapse patients, reported by groups such as Sweetenham and colleagues 34 and Arranz et al 40 Thus, superior results for second complete remission patients may not be the result of a beneficial effect of re-induction therapy but rather from identification of good prognosis patients.…”

“…Reported diseasefree and overall survival rates are as high as 61-79%. [32][33][34][35][36][37][38][39] Although all of the series in Table 7 examined the outcome of autotransplantation in first relapse, eligibility criteria differed. For example, the studies by Yahalom et al, 32 Chopra et al, 33 and Nademanee et al 35 included only patients relapsing within 1 year of completing therapy and/or failing to respond to salvage chemotherapy.…”

“…Factors predicting poor outcome in prior studies of autotransplants for relapsed or refractory Hodgkin's disease a Interval from end-of-therapy until relapse Ͻ12 months (34,36,39) у1 extra-nodal disease site at relapse (34,35,39,40) Abnormal ECOG performance status (38,43,46,49,51,52) a Resistant relapse (38,42,47) a B symptoms at relapse (39,48,49) Bulk disease at transplant (33,40,41,44,49,53) Female gender (33) Exposure to many chemotherapeutic regimens prior to transplant (33,35,46,47,51,52) Elevated serum LDH at transplant (50) Relapse in previous radiation field (44) Disseminated lung or marrow disease at relapse (49) a Factors reported specifically in first relapse/second complete remission patients. Numbers in parenthesis refer to study cited.…”

Analysis of feasibility of myeloablative therapy and autologous peripheral stem cell (PBSC) transplantation in the elderly: an interim report

“…[1][2][3][4][5][6][7] Nevertheless most reports focus on patients younger than 60 years due to higher procedurerelated risk in older patients. [6][7][8] Few reports concerning the use of high-dose therapy and autologous bone marrow 6,8 or peripheral stem cell transplantation 9,10 in the elderly are available, although growing interest in treating older patients has been shown.…”

Front-line high-dose therapy with autologous stem cell transplantation for high risk Hodgkin's disease: comparison with combined-modality therapy

“…3 Such patient survival has been improved with the use of high-dose therapy and autologous stem cell transplantation (ASCT) that currently gives a 5-year survival of about 50%. [4][5][6][7] However, these results also mean that at least half of the relapsed patients are not cured with ASCT. For this reason, ASCT has been proposed as the treatment of choice in first incomplete response (IR) 8 or even in first complete response 9 in a subset of patients at a high risk of relapse, the risk being defined mainly by the clinical stage (CS) and the tumor burden.…”