title: High-dose chemotherapy and autologous stem cell transplantation for primary refractory or relapsed Hodgkin lymphoma: long-term outcome in the first 100 patients treated in Vancouver.
abstract: Beginning in 1985, patients in British Columbia with Hodgkin lymphoma (HL) that was not controlled by conventional chemotherapy routinely underwent high-dose chemotherapy and autologous stem cell transplantation (HD-ASCT). Long-term complications of HD-ASCT have become apparent as more patients survive without recurrence of HL. Data were obtained retrospectively on the first 100 patients that underwent HD-ASCT for HL in Vancouver, focusing on relapse, treatment-related complications, and the occurrence of late events. Fifty-three patients remain alive (median follow-up, 11.4 years [range, 10.0-17.4 years]) with an overall survival (OAS) of 54% at 15 years. OAS was significantly better in patients in first relapse (67%) than in patients with primary refractory-induction failure (39%) and advanced disease (29%) (P = .002). The major cause of death was progression of HL (32% at 15 years). Treatment-related mortality, including death from second malignancy, was 17% at 15 years. Cumulative risk of a second malignancy was 9% at 15 years. Karnofsky performance status was at least 90% in 47 patients although hypogonadism (20 patients), hypothyroidism (12 patients), unusual infections (10 patients), anxiety or depression (7 patients), and cardiac disease (5 patients) were not uncommon in survivors. HD-ASCT can lead to durable remissions in relapsed or refractory HL with acceptable but definite late toxicity. The occurrence of late events necessitates lifelong medical surveillance.
authors.affiliation: Leukemia/Bone Marrow Transplantation Program of British Columbia, Division of Hematology, Vancouver General Hospital, Vancouver, BC, Canada. jlavoie@bccancer.bc.ca
authors.forename: Julye C
authors.initials: JC
authors.lastname: Lavoie
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Connors
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Phillips
authors.forename: Donna E
authors.initials: DE
authors.lastname: Reece
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barnett
authors.forename: Donna L
authors.initials: DL
authors.lastname: Forrest
authors.forename: Randy D
authors.initials: RD
authors.lastname: Gascoyne
authors.forename: Donna E
authors.initials: DE
authors.lastname: Hogge
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Nantel
authors.forename: John D
authors.initials: JD
authors.lastname: Shepherd
authors.forename: Clayton A
authors.initials: CA
authors.lastname: Smith
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Song
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Sutherland
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Toze
authors.forename: Nicholas J S
authors.initials: NJ
authors.lastname: Voss
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Nevill
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use* / Q000633:toxicity; D002170:Canada; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006689:Hodgkin Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000139:chemically induced / Q000401:mortality; D011336:Probability; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome