title: Comparison of high-dose therapy and autologous stem-cell transplantation with conventional therapy for Hodgkin's disease induction failure: a case-control study. Société Francaise de Greffe de Moelle.
abstract: OBJECTIVE
  To determine the prognostic factors and outcome of first-line induction failure Hodgkin's disease patients who were treated with a salvage regimen of high-dose chemotherapy and autologous stem-cell transplantation, and to compare them with matched, conventionally treated patients.
  
  
  METHODS
  We retrospectively analyzed data relating to 86 Hodgkin's disease patients who underwent autologous stem-cell transplantation after failure of the first chemotherapy regimen, either because they did not enter a complete remission and experienced progression of disease less than 3 months after the end of their first-line treatment or because they showed evidence of disease progression during first-line therapy. Graft patients were matched with 258 conventionally treated patients (three controls per case) for age, sex, clinical stage, B symptoms, and time at risk; patient data were obtained from international databases.
  
  
  RESULTS
  Among the 86 graft patients, the median age at diagnosis was 29 years (range, 14 to 57 years). Thirty-nine percent of patients had stage II disease, 23% had stage III disease, and 38% had stage IV disease. Seventy percent of the patients received chemotherapy and 30% received combined modality therapy; 60% of the patients received a seven- or eight-drug regimen. After this first-line treatment, 91% had disease progression and 9% had a brief partial response. Eighty patients received a second-line treatment; pretransplantation status was as follows: 24% of patients had a complete remission, 38% had a partial remission (PR), 14% had stable disease, and disease progression occurred in 24%. With a median follow-up of 22 months (range, 4 to 105 months) from diagnosis, the 5-year event-free survival and overall survival rates from transplantation were 25% and 35% (95% confidence intervals, 15 to 36 and 23 to 49), respectively. In multivariate analysis, the pretransplantation disease status after salvage therapy was the only significant prognostic factor for survival (PR: relative risk = 2.8, P = .017; progressive disease: relative risk (RR) = 5.26, P < .001). From diagnosis, the 6-year overall survival rates of the graft patients and 258 matched conventionally treated patients were 38% and 29%, respectively (P = .058).
  
  
  CONCLUSIONS
  Autologous stem-cell transplantation represents the best therapeutic option currently available for patients with primary induction failure and is associated with acceptable toxicity. Response to second-line treatment before high-dose chemotherapy is the only prognostic factor that can be correlated with survival.
authors.affiliation: Hematology Institute, Hôpital Saint-Louis, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: André
authors.forename: M
authors.initials: M
authors.lastname: Henry-Amar
authors.forename: J L
authors.initials: JL
authors.lastname: Pico
authors.forename: P
authors.initials: P
authors.lastname: Brice
authors.forename: D
authors.initials: D
authors.lastname: Blaise
authors.forename: M
authors.initials: M
authors.lastname: Kuentz
authors.forename: B
authors.initials: B
authors.lastname: Coiffier
authors.forename: P
authors.initials: P
authors.lastname: Colombat
authors.forename: J Y
authors.initials: JY
authors.lastname: Cahn
authors.forename: M
authors.initials: M
authors.lastname: Attal
authors.forename: J
authors.initials: J
authors.lastname: Fleury
authors.forename: N
authors.initials: N
authors.lastname: Milpied
authors.forename: G
authors.initials: G
authors.lastname: Nedellec
authors.forename: P
authors.initials: P
authors.lastname: Biron
authors.forename: H
authors.initials: H
authors.lastname: Tilly
authors.forename: J P
authors.initials: JP
authors.lastname: Jouet
authors.forename: C
authors.initials: C
authors.lastname: Gisselbrecht
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure