title: Long-term results of autologous stem cell transplantation for primary refractory or relapsed Hodgkin's lymphoma.
abstract: Autologous hematopoietic stem cell transplantation (ASCT) has become standard therapy for primary refractory (PR REF) or relapsed (REL) Hodgkin's lymphoma (HL); however, more than half of these patients eventually relapse and die of their disease. We studied long-term outcomes and evaluated factors influencing progression-free survival (PFS) in 141 patients with PR REF or REL HL who underwent ASCT between 1985 and 2003. Median age at ASCT was 30 years (range, 7-60 years); 21 patients had PR REF, and 120 had REL HL. With a median follow-up of 6.3 years (range, 1-20 years), the probability of PFS at 5 and 10 years was 48% (95% confidence interval [CI], 39%-57%) and 45% (95% CI, 36%-54%) and that of overall survival (OS) was 53% (95% CI, 44%-62%) and 47% (95% CI, 37%-57%), respectively. Transplant-related mortality at 100 days was 1.4%. Among 45 5- to 20-year survivors, no late relapses of HL were observed. In multivariate analysis, 3 factors were independently predictive of poor PFS: chemoresistant disease (relative risk [RR], 2.9; 95% CI, 1.7-5.0), B-symptoms at pretransplantation relapse (RR, 2.1; 95% CI, 1.3-3.4), and presence of residual disease at the time of transplantation (RR, 2.3; 95% CI, 1.1-4.8). Patients with 0 or 1 of these 3 adverse factors (low-risk disease) had a 5-year PFS of 67% (95% CI, 55%-79%) compared with 37% (95% CI, 22%-52%) in those with 2 factors (intermediate-risk group) and 9% (95% CI, 0-20%) in those with all 3 factors (high-risk group) (P < .001). The rates of OS at 5 years were 71% (95% CI, 60%-82%), 49% (95% CI, 33%-65%) and 13% (95% CI, 0-27%) in the 3 groups, respectively (P < .001). ASCT is associated with durable PFS in appropriately selected patients with PR REF or REL HL. Using a simple prognostic model, we can identify patients with high-risk disease who have predictably unfavorable outcome after ASCT and require novel therapeutic approaches. A risk-adapted approach should be followed in determining treatment options for patients with PR REF and REL HL.
authors.affiliation: Blood and Marrow Transplant Program, Divisions of Medical and Pediatric Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Todd E
authors.initials: TE
authors.lastname: Defor
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Miller
authors.forename: Philip B
authors.initials: PB
authors.lastname: McGlave
authors.forename: Arne
authors.initials: A
authors.lastname: Slungaard
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.forename: Norma K C
authors.initials: NK
authors.lastname: Ramsay
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Orchard
authors.forename: Margaret L
authors.initials: ML
authors.lastname: MacMillan
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D016026:Bone Marrow Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D002648:Child; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D016879:Salvage Therapy; D014182:Transplantation, Autologous / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D047368:Tumor Burden; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D011241:Prednisone