Tandem Autologous Stem Cell Transplantation for Patients with Primary Refractory or Poor Risk Recurrent Hodgkin Lymphoma

Abstract

primary progressive (n = 28) or recurrent HL (n = 18) with at least 1 of the following poor prognostic factors: first complete remission (CR) <12 months (n = 15) or extra-nodal disease (n = 4) or B symptoms at relapse (n = 4). The first cycle consisted of melphalan (150 mg/m(2)) alone. The second cycle consisted of fractionated total body irradiation (FTBI) 1200 cGy or BCNU (450 mg/m(2)) in combination with etoposide (60 mg/kg) and cyclophosphamide (100 mg/kg). Of the 46 patients, 5 (11%) did not receive the planned tandem transplants because of inadequate stem cell collection for 2 ASCT. After a median of 64 days (25-105), 41 patients received the second ASCT. With a median follow-up of 5.3 years (1.6-8.1), the 5-year estimate of overall survival, progression-free survival, and freedom from progression were 54% (95% confidence interval [CI] 40%-69%), 49% (95% CI, 34%-63%), and 55% (95%CI, 40%-70%), respectively. Our mature results from this study suggest that in patients with primary progressive or poor risk recurrent HL, this tandem ASCT program is effective and well tolerated and compares favorably with the conventional single transplant.

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

“…31,57,58 Fung et al also suggested that in primary progressive and poor-risk recurrent HL a tandem ASCT program was effective and compared favorably with the conventional single transplant. 59 With the same goal of improving survival in patients with multiple risk factors, Moskowitz et al conducted a study of risk-adapted salvage treatment. In this program, all patients were treated with ICE-based protocols and were offered, if proven chemosensitive, ASCT with Classical Hodgkin's lymphoma: LYSA guidelines haematologica | 2013; 98 (8) 1189 Figure 2.…”

High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant

“…12,[24][25][26] In the setting of double HDC, a prospective study from the former GELA/SFGM group showed that, in the higher-risk group of patients (refractory and with more than two adverse prognostic factors), this approach of the 5-year freedom from second failure and OS was 41% and 52%, respectively, with the better results in those with chemosensitive disease to salvage therapy. 27 In a pilot study adopting the double HDC approach, Fung et al 28 reported that, in refractory or poor-prognosis patients, the 5-year OS, PFS and freedom from progression were 54%, 49% and 55%, respectively. In a retrospective study, the double HDC approach was more effective in patients achieving FDG-PET-defined PR, than single HDC (5-year PFS 43% vs 0%).…”

Total body irradiation, etoposide, cyclophosphamide, and autologous peripheral blood stem-cell transplantation followed by randomization to therapy with interleukin-2 versus observation for patients with non-Hodgkin lymphoma: results of a phase 3 randomized trial by the Southwest Oncology Group (SWOG 9438)

“…25,27 The TRM observed in the current trial may be due to enrollment of many heavily pretreated patients; by contrast, the same preparative regimen used in different patient populations who were less heavily pretreated was associated with TRM of only 1% to 4%. 28,29 Non-TBI-containing preparative regimens should be recommended in heavily pretreated patients with relapsed/ refractory NHL. The use of radioimmunotherapy is one approach under development to avoid TBI, and this technique for delivery of radiotherapy as part of the preparative regimen may be as effective if not more effective than TBI.…”