Long-term outcome of autologous stem-cell transplantation in relapsed or refractory Hodgkin's lymphoma.
BACKGROUND
The purpose of this study was to assess prognostic factors and outcome of patients with relapsed/refractory Hodgkin's lymphoma (HL) who received high-dose chemotherapy and autologous stem-cell transplant (ASCT).


METHODS
Data on 195 patients who received ASCT between 1985 and June 2005 were reviewed. Median time from first treatment to ASCT was 2.6 years (0.4-27.3). Demography at ASCT was 61% stage IV, median age 31 years (18-69), median prior treatment (tx) regimens 3 (2-7), median Hasenclever index 3 (0-6); 150 patients had responding disease [54 complete remission (CR), 96 partial remission (PR)], and 45 patients had untested relapse/refractory disease.


RESULTS
Post-ASCT, 61% (119/195) patients attained CR with an overall response (CR + PR) of 85%. Twelve patients had nonrelapse mortality. Of 119 patients attaining CR, 27 relapsed: 3 after attaining CR for >5 years and 1 after attaining CR for >10 years. Median overall survival (OS)/progression-free survival (PFS) from ASCT was 9 years/2.9 years. Five-year OS/PFS was 55% of 44% and 10-year OS/PFS was 49.4% of 37% for whole group. Twenty (10%) patients developed second cancer (seven secondary acute myeloid leukaemia (AML)/myelodysplastic syndrome (MDS)). Probability of developing second cancer at 10 years was 14.7% (95% confidence interval 8.9% to 23.8%) and 24.8% at 19 years.


CONCLUSIONS
These data provide the longest follow-up reported for patients receiving ASCT for relapsed/refractory HL. In addition to previously described prognostic factors, our data show that Hasenclever index <3 influences outcome favorably and attaining CR at ASCT leads to a better outcome.
Sirohi
B
B
Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
Cunningham
D
D
Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK. Electronic address: david.cunningham@rmh.nhs.uk.
Powles
R
R
Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
Murphy
F
F
Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
Arkenau
T
T
Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
Norman
A
A
Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
Oates
J
J
Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
Wotherspoon
A
A
Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
Horwich
A
A
Lymphoma Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK.
D000293:Adolescent; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000473:pathology; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000473:pathology; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide; D008558:Melphalan; D002330:Carmustine