Outcome and prognostic factors in advanced Hodgkin's disease treated with high-dose chemotherapy and autologous stem cell transplantation: a study of 341 patients.
BACKGROUND
The reported probability of survival of patients with Hodgkin's disease (HD) following high-dose chemotherapy with autologous stem cell transplantation (HDC/ASCT) is 35-65% at 5 years. The Polish Lymphoma Research Group investigated retrospectively prognostic factors for overall survival (OS) and event-free survival (EFS), and the risk of secondary malignancies in a large series of patients who underwent HDC/ASCT.


METHODS
The data of 341 consecutive patients treated in 10 centers from 1990 to 2002 were collected and analyzed.


RESULTS
The actuarial 5-year OS and EFS were 64% [95% confidence interval (CI) 57% to 71%] and 45% (95% CI 39% to 51%), respectively. In the multivariate model, unfavorable prognostic factors for EFS were less than partial response at the time of ASCT [relative risk (RR), 2.92 (95% CI 1.68-5.08); P<0.001] and three or more previous chemotherapy lines (RR, 2.16; 95% CI 1.42-3.30; P<0.001). These two factors were also associated with unfavorable OS (RR, 3.32; 95% CI 1.90-5.79; P<0.001 and RR, 2.34, 95% CI 1.51-3.64; P<0.001). Five-year cumulative risk of secondary malignancy was 8.4% (95% CI 2% to 13%) and the only identified risk factor was splenectomy (P=0.02).


CONCLUSIONS
HDC/ASCT should be considered early in the course of disease for patients with a response after standard therapy.
Czyz
J
J
Medical University of Gdansk, Gdansk, Poland. jczyz@amg.gda.pl
Dziadziuszko
R
R
Knopinska-Postuszuy
W
W
Hellmann
A
A
Kachel
L
L
Holowiecki
J
J
Gozdzik
J
J
Hansz
J
J
Avigdor
A
A
Nagler
A
A
Osowiecki
M
M
Walewski
J
J
Mensah
P
P
Jurczak
W
W
Skotnicki
A
A
Sedzimirska
M
M
Lange
A
A
Sawicki
W
W
Sulek
K
K
Wach
M
M
Dmoszynska
A
A
Kus
A
A
Robak
T
T
Warzocha
K
K
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome