title: A prognostic model for prolonged event-free survival after autologous or allogeneic blood or marrow transplantation for relapsed and refractory Hodgkin's disease.
abstract: There are several prognostic models for Hodgkin's disease (HD) patients, but none evaluating patient characteristics at time of blood and marrow transplantation (BMT). We developed a prognostic model for event-free survival (EFS) post-BMT based on HD patient characteristics measured at the time of autologous (auto) or allogeneic (allo) BMT. Between 1/1991 and 12/2001, 64 relapsed or refractory HD patients received an auto (n=46) or allo (n=18) BMT. A multivariate prognostic model was developed measuring time to relapse, progression or death. Median follow-up was 51.7 months; median EFS for auto and allo BMT was 36 and 3 months, respectively (P=0.001). Significant multivariate predictors of shorter EFS were chemotherapy-resistant disease, KPS <90 and > or =3 chemotherapy regimens pre-BMT. Patients with two to three adverse factors had significantly shorter EFS at 2 years (58 vs 11% in auto; 38 vs 0% in allo BMT patients). Despite a selection bias favoring auto BMT, the model was valid in both auto and allo BMT groups. We were able to differentiate patients at high vs low risk for adverse outcomes post-BMT. This prognostic model may prove useful in predicting patient outcomes and identifying high-risk patients for novel treatment strategies. Validation of this model in a larger cohort of patients is warranted.
authors.affiliation: Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA. theresa.hahn@roswellpark.org
authors.forename: T
authors.initials: T
authors.lastname: Hahn
authors.forename: M
authors.initials: M
authors.lastname: Benekli
authors.forename: C
authors.initials: C
authors.lastname: Wong
authors.forename: K B
authors.initials: KB
authors.lastname: Moysich
authors.forename: A
authors.initials: A
authors.lastname: Hyland
authors.forename: A M
authors.initials: AM
authors.lastname: Michalek
authors.forename: A
authors.initials: A
authors.lastname: Alam
authors.forename: M R
authors.initials: MR
authors.lastname: Baer
authors.forename: B
authors.initials: B
authors.lastname: Bambach
authors.forename: M S
authors.initials: MS
authors.lastname: Czuczman
authors.forename: M
authors.initials: M
authors.lastname: Wetzler
authors.forename: J L
authors.initials: JL
authors.lastname: Becker
authors.forename: P L
authors.initials: PL
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000401:mortality; D002423:Cause of Death; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006085:Graft Survival; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality; D011379:Prognosis; D016879:Salvage Therapy; D016019:Survival Analysis; D013995:Time; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous