Progressive disease following autologous transplantation in patients with chemosensitive relapsed or primary refractory Hodgkin's disease or aggressive non-Hodgkin's lymphoma

Abstract

Summary:To determine the outcome of patients with chemosensitive relapsed or primary refractory Hodgkin's disease (HD) or aggressive non-Hodgkin's lymphoma (NHL) whose disease progresses after autologous stem cell transplantation (ASCT), we reviewed the records of 82 patients with HD and 139 patients with NHL transplanted between 1993 and 2000. Disease progression occurred in 25 patients with HD and 66 patients with NHL, with median times to progression (TTP) of 3.8 and 5.1 months, respectively. Median survival times following ASCT failure were 26 and 7.7 months for patients with HD and NHL, respectively. The second-line international prognostic index (sIPI) and the TTP (before or after 3 months from ASCT) independently were predictive of survival for NHL patients. In addition, treatment with rituximab for patients with B cell NHL was associated with improved survival (median 28.6 vs 4.1 months, P ¼ 0.003), independent of the sIPI and TTP. Prognostic factors for patients with HD were not identified. Only two patients, one of whom was among six patients who received second autologous transplants, remain disease-free. The uniformly poor outcome associated with disease progression after ASCT should prompt efforts to assess the feasibility and utility of detecting and treating post transplant residual disease during a minimal disease state, before overt progression.

Stem cell transplantation for pediatric lymphoma: past, present and future

“…43,54 A high rate of relapse has been demonstrated after highdose therapy and AutoSCT in adult patients with relapsed HD. 61 This is similar to that being reported in the pediatric literature. Lieskovsky et al 55 also report a high incidence and late failures in their series; 38% of deaths occurred 4-12 years after transplantation and 15% of the patients relapsed after more than 2 years post-AutoSCT (Table 2).…”

Second hematopoietic SCT for lymphoma patients who relapse after autotransplantation: another autograft or switch to allograft?

“…In two reports, survival was longer for patients who received rituximab compared with patients who did not receive Ab therapy for post-transplant relapse. 8,9 Many of these reports, however, were published before the widespread use of rituximab as part of the initial lymphoma therapy.…”

“…8,15,[31][32][33] Despite this limitation, several conclusions can be reached by analyzing these early studies. First, the treatment-related mortality (TRM) was higher than expected after an initial auto-HSCT and ranged from 11 to 40%.…”

“…Approximately 60% of the patients had diffuse large B-cell lymphoma and one-third had follicular lymphoma. Patients had been treated with a median of three previous therapies (range [1][2][3][4][5][6][7][8][9] and the median time after auto-HSCT was 28 months. The authors determined that a 0.2 mCi/kg ibritumomab tiuxetan dose was safe and effective for this population of heavily pretreated patients and half attained a response.…”

“…[4][5][6] Unfortunately, relapse remains the most common cause of failure after auto-HSCT and the prognosis of such patients is poor. [7][8][9] As thousands of HL and NHL patients undergo auto-HSCT each year, clinicians frequently face the dilemma of how to manage those patients who relapse. Second transplants, autologous or allogeneic, frequently are considered for patients who relapse after auto-HSCT.…”