Outcome analysis of high-dose chemotherapy and autologous stem cell transplantation in adolescent and young adults with relapsed or refractory Hodgkin lymphoma

Abstract

High-dose chemotherapy (HDC) and autologous stem cell transplantation (auto-SCT) can salvage many patients with relapsed or refractory Hodgkin's lymphoma (HL). We are reporting the outcome of HDC auto-SCT and the impact of 21 prognostic factors in relapsed and refractory adolescent (14-21 years) and young adult (>21-30 years) (AYA) HL patients. We used Fine and Gray's competing risk analysis method and regression model for outcome analysis. From 1996 to 2013, 290 consecutive patients with biopsy-proven HL underwent HDC auto-SCT for relapsed/refractory HL; 216 patients (74.5 %) were AYA at the time of auto-SCT. Male/female were equal, median age at auto-SCT was 22.4 years, and there were 94 adolescent (43.5 %) and 122 young adults (56.5 %). There was refractory disease in 121 (56 %) patients, relapsed in 95 (44 %). Median follow-up was 72.6 months. The Kaplan-Meier method estimated that 5-year overall survival is 62.7 % (adolescents (63.5 %), young adults (62 %)) and event-free survival was 51.3 %. Five-year cumulative incidence of disease-specific death (DS-death) is 33 % and that of DS-event is 45 %. For DS-death, the multivariate analysis identified complete remission (CR) duration of <12 months (hazard ratio (HR) 3.61, P = 0.0009), no CR after salvage (HR: 3.93, P = 0.0002), and nodular sclerosis pathology (HR 3.3, P = 0.016) and positive B symptoms (HR 2, P = 0.028) as negative factors. For DS-event, CR duration of <12 months (HR 1.88, P = 0.02), no CR after salvage (HR 3.47, P = 0.000005) and nodular sclerosis pathology (HR 1.88, P = 0.02) were found significant. The Kaplan-Meier method estimated overall survival (OS) at 36 months with 0-2:3:4 factors being 93.6:54:21 %, respectively (P value <0.001). Kaplan-Meier estimated event-free survival (EFS) at 36 months with 0-1:2:3 factors being 84.6:65:31 %, respectively (P value <0.001). Clinically, adolescents have similar outcomes as young adults.

Hodgkin lymphoma in adolescent and young adults: insights from an adult tertiary single-center cohort of 349 patients

“…Our data are in line with the clinical characteristics at diagnosis of the AYA population included in Akhtar et al cohort, i.e. high rate of disseminated disease (65 %), of mediastinal involvement (70 %), and of extra-nodal involvement (43 %) [ 19 ].…”

Clinical Impact of Colonization with Multidrug-Resistant Organisms on Outcome after Autologous Stem Cell Transplantation: A Retrospective Single-Center Study

“…In our study, the median follow-up time 21.5 months and the OS was 70.9%. These data for OS are in the range of previously described data after auto-HSCT [15,16]. Of 184 patients in the study, 21% were colonized by MDRO, particularly by E. coli-ESBL/FQ and VRE, the latter being the only multidrug-resistant gram-positive organism in our cohort.…”

Unique Challenges of Hematopoietic Cell Transplantation in Adolescent and Young Adults with Hematologic Malignancies

“…In a single-institution study of Hodgkin lymphoma, Shafer et al [19] reported an OS of 73% and a progression-free survival of 60% in AYAs treated with autologous HCT. Other studies have highlighted the impact of negative prognostic factors, such as short duration of complete remission, nodular sclerosis pathology, and B symptoms, on outcomes of autologous HCT for Hodgkin lymphoma [20]. A recent CIBMTR study examined long-term outcomes in patients with lymphoma who had survived at least 2 years after undergoing autologous HCT [21].…”