Prognostic factors and long-term outcome of autologous haematopoietic stem cell transplantation following a uniform-modified BEAM-conditioning regimen for patients with refractory or relapsed Hodgkin lymphoma: a single-center experience

Abstract

Despite the well-defined role of autologous haematopoietic stem cell transplantation (autoHCT) in the treatment of patients with relapsed or refractory Hodgkin lymphoma (HL), relapse remains the main cause of transplant failure. We retrospectively evaluated long-term outcome and prognostic factors affecting survival of 132 patients with refractory (n = 89) or relapsed HL (n = 43) treated with autoHCT following modified BEAM. With a median follow-up of 68 months, the 10-year overall survival (OS) and progression-free survival (PFS) were 76 and 66 %, respectively. The 10-year cumulative incidence of second malignancies was 7 %. In multivariate analysis, age ≥45 years, more than one salvage regimens and disease status at transplant worse than CR were factors predictive for poor OS. In relapsed HL, age at transplant, response duration (<12 vs. ≥12 months) and the number of salvage regimens were independent predictors for PFS. In the refractory setting, disease status at autoHCT and the number of salvage regimens impacted PFS. The number of risk factors was inversely correlated with PFS in both relapsed and refractory HL (p = 0.003 and <0.001, respectively). The median PFS for patients with >1 risk factor in the relapsed and refractory setting was 5 and 11 months, respectively, in comparison with the median PFS not reached for patients with 0–1 risk factor in both settings. We conclude that high proportion of patients with relapsed/refractory HL can be cured with autoHCT. However, the presence of two or more risk factors helps to identify poor prognosis patients who may benefit from novel treatment strategies.

Long‐term outcomes among 2‐year survivors of autologous hematopoietic cell transplantation for Hodgkin and diffuse large b‐cell lymphoma

“…With a median follow‐up of 7.6 years and with 68% having received total body irradiation (TBI)–based preparative regimens, the cohort had a 13‐fold increased risk of late death in comparison with the general population. Subsequent reports have confirmed an increased risk of late mortality . In addition, mostly single‐center studies have reported high rates of organ impairment, functional limitations, and subsequent malignant neoplasms (SMNs) in auto‐HCT survivors …”

“…Subsequent reports have confirmed an increased risk of late mortality. [10][11][12][13] In addition, mostly single-center studies have reported high rates of organ impairment, functional limitations, and subsequent malignant neoplasms (SMNs) in auto-HCT survivors. [13][14][15] To address the gaps in the literature, we selected a representative, multicenter cohort of 2-year disease-free survivors of auto-HCT for cHL or DLBCL who were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR).…”

Role of Positron-Emission Tomography in Prognosis of Outcomes of High-Dose Chemotherapy with Autologous Hematopoietic Stem Cell Transplantation in Hodgkin’s Lymphoma

“…В некоторых работах продемонстрировано ухудшение показателей выживаемости при необходимости перехода на другой вариант лечения второй линии [33,34]. Согласно нашему наблюдению, прогноз у пациентов с 3 и более линий химиотерапии в анамнезе также ухудшался.…”

Conditional survival and excess mortality after high-dose therapy with autologous stem cell transplantation for adult refractory or relapsed Hodgkin lymphoma in Norway

“…A populationbased Australian study (n=7765) reported a similar 10-year incidence of second malignancies after HDT-ASCT for any cancer (5%), 14 which is lower than reports on HL survivors specifically after HDT-ASCT. [8][9][10] Some of these studies, however, had a median follow-up time of over ten years from HDT-ASCT. We only have information from the Cancer Registry until the end of 2011, and it is likely that the number of cases of second malignancies will increase haematologica 2015; 100:e242 LETTERS TO THE EDITOR Figure 2.…”