Risk-adapted salvage treatment with single or tandem autologous stem-cell transplantation for first relapse/refractory Hodgkin's lymphoma: results of the prospective multicenter H96 trial by the GELA/SFGM study group.
OBJECTIVE
A prospective multicenter trial evaluated a risk-adapted salvage treatment with single or tandem autologous stem-cell transplantation (ASCT) for 245 Hodgkin's lymphoma (HL) patients who experience treatment failure with first-line therapy.


METHODS
Poor-risk patients (150 with primary refractory disease or > or = two of the following risk factors at first relapse: time to relapse < 12 months, stage III or IV at relapse, and relapse within previously irradiated sites) or intermediate-risk patients (95 with one risk factor at relapse) were eligible for tandem or single ASCT, respectively.


RESULTS
Among poor-risk patients, 105 (70%), including 30 of 55 with cytoreductive chemotherapy-resistant disease, received tandem ASCT, whereas 92 intermediate-risk patients (97%) received single ASCT. According to intent-to-treat analysis, the 5-year freedom from second failure and overall survival (OS) estimates were 73% and 85%, respectively, for the intermediate-risk group and 46% and 57%, respectively, for the poor-risk group. Outcomes were similar for primary refractory and poor-risk/relapsed HL. For patients with chemotherapy-resistant disease, the 46% 5-year OS rate achieved with tandem ASCT compares favorably with the previously reported 30%. Outcomes for partial and complete responders to cytoreduction receiving tandem ASCT did not differ significantly and were better than those previously reported for partial responders receiving single ASCT, but not superior to those reported for complete responders receiving single ASCT. Six poor-risk patients (4%) died from toxicity.


CONCLUSIONS
Single ASCT is appropriate for intermediate-risk patients. For poor-risk patients, our results suggest a benefit of tandem ASCT for half of the patients with chemotherapy-resistant disease and partial responders, but not for complete responders to cytoreductive chemotherapy.
Morschhauser
Franck
F
Service des Maladies du Sang, Hôpital Huriez, Centre Hospitalier Universitaire Lille, rue Michel Polonovski, 59037 Lille Cedex, France. f-morschhauser@chru-lille.fr
Brice
Pauline
P
Fermé
Christophe
C
Diviné
Marine
M
Salles
Gilles
G
Bouabdallah
Reda
R
Sebban
Catherine
C
Voillat
Laurent
L
Casasnovas
Olivier
O
Stamatoullas
Aspasia
A
Bouabdallah
Krimo
K
André
Marc
M
Jais
Jean-Philippe
JP
Cazals-Hatem
Dominique
D
Gisselbrecht
Christian
C
D000293:Adolescent; D000328:Adult; D005260:Female; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D033581:Stem Cell Transplantation / Q000379:methods*; D016896:Treatment Outcome