title: LACE-conditioned autologous stem cell transplantation for relapsed or refractory Hodgkin's lymphoma: treatment outcome and risk factor analysis in 67 patients from a single centre.
abstract: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a recognized treatment option for patients with relapsed Hodgkin's lymphoma. We have analysed 67 patients who underwent ASCT after LACE (lomustine (CCNU), cytarabine (Ara-C), cyclophosphamide, etoposide) conditioning for relapsed (n=61) or primary refractory (n=6) Hodgkin's lymphoma. The 100-day treatment-related mortality was 3%. With a median follow-up of 67 months (range 3.3-161.0) the probabilities of overall survival (OS) and progression-free survival (PFS) at 5 years were 68 and 64%, respectively. Probabilities for OS and PFS at 5 years for patients with chemosensitive relapse (n=40) were 81 and 78% versus 50 and 35%, respectively, for patients (n=27) with chemoresistant relapse (P=0.012 for OS, P=0.002 for PFS). In multivariate analysis mixed cellularity classical or lymphocyte-depleted classical histology subtype and haemoglobin level of 10 g/dl or less at the time of ASCT were identified as risk factors for worse OS, whereas stage III or IV disease at diagnosis and disease status at ASCT other than complete or partial remission predicted inferior PFS. LACE followed by ASCT is an effective treatment for the majority of patients with chemosensitive relapsed Hodgkin's lymphoma and a proportion of chemorefractory patients also benefit.
authors.affiliation: Department of Haematology, Hammersmith Hospitals NHS Trust, Imperial College School of Medicine, London, UK.
authors.forename: J B
authors.initials: JB
authors.lastname: Perz
authors.forename: C
authors.initials: C
authors.lastname: Giles
authors.forename: R
authors.initials: R
authors.lastname: Szydlo
authors.forename: D
authors.initials: D
authors.lastname: O'Shea
authors.forename: J
authors.initials: J
authors.lastname: Sanz
authors.forename: A
authors.initials: A
authors.lastname: Chaidos
authors.forename: S
authors.initials: S
authors.lastname: Wagner
authors.forename: J
authors.initials: J
authors.lastname: Davis
authors.forename: S
authors.initials: S
authors.lastname: Loaiza
authors.forename: D
authors.initials: D
authors.lastname: Marin
authors.forename: J
authors.initials: J
authors.lastname: Apperley
authors.forename: E
authors.initials: E
authors.lastname: Olavarria
authors.forename: A
authors.initials: A
authors.lastname: Rahemtulla
authors.forename: I
authors.initials: I
authors.lastname: Lampert
authors.forename: K
authors.initials: K
authors.lastname: Naresh
authors.forename: D
authors.initials: D
authors.lastname: Samson
authors.forename: D
authors.initials: D
authors.lastname: MacDonald
authors.forename: E J
authors.initials: EJ
authors.lastname: Kanfer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000401:mortality; D013997:Time Factors; D019172:Transplantation Conditioning / Q000401:mortality; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D005047:Etoposide; D008130:Lomustine; D003520:Cyclophosphamide