title: Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin's lymphoma: identification of prognostic factors predicting outcome.
abstract: BACKGROUND
  The role of reduced intensity conditioning allogeneic stem transplantation (RICalloSCT) in the management of patients with Hodgkin's lymphoma remains controversial.
  
  
  METHODS
  To further define its role we have conducted a retrospective analysis of 285 patients with HL who underwent a RICalloSCT in order to identify prognostic factors that predict outcome. Eighty percent of patients had undergone a prior autologous stem cell transplantation and 25% had refractory disease at transplant.
  
  
  RESULTS
  Non-relapse mortality was associated with chemorefractory disease, poor performance status, age >45 and transplantation before 2002. For patients with no risk factors the 3-year non-relapse mortality rate was 12.5% compared to 46.2% for patients with 2 or more risk factors. The use of an unrelated donor had no adverse effect on the non-relapse mortality. Acute graft versus host disease (aGVHD) grades II-IV developed in 30% and chronic GVHD in 42%. The development of cGVHD was associated with a lower relapse rate. The disease progression rate at one and five years was 41% and 58.7% respectively and was associated with chemorefractory disease and extent of prior therapy. Donor lymphocyte infusions were administered to 64 patients for active disease of whom 32% showed a clinical response. Eight out of 18 patients receiving donor lymphocyte infusions alone had clinical responses. Progression-free and overall survival were both associated with performance status and disease status at transplant. Patients with neither risk factor had a 3-year PFS and overall survival of 42% and 56% respectively compared to 8% and 25% for patients with one or more risk factors. Relapse within six months of a prior autologous transplant was associated with a higher relapse rate and a lower progression-free.
  
  
  CONCLUSIONS
  This analysis identifies important clinical parameters that may be useful in predicting the outcome of RICaIICalloSCT in Hodgkin's lymphoma.
authors.affiliation: BMT Unit, Bristol Children's Hospital, UK. stephen.robinson@ubht.swest.nhs.uk
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Robinson
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
authors.forename: Carmen
authors.initials: C
authors.lastname: Canals
authors.forename: Nigel
authors.initials: N
authors.lastname: Russell
authors.forename: Dolores
authors.initials: D
authors.lastname: Caballero
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Arturo
authors.initials: A
authors.lastname: Iriondo
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
authors.forename: Andrew
authors.initials: A
authors.lastname: Pettitt
authors.forename: Gerard
authors.initials: G
authors.lastname: Socie
authors.forename: Francesca
authors.initials: F
authors.lastname: Bonifazi
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Effie
authors.initials: E
authors.lastname: Liakopoulou
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.forename: Fiona
authors.initials: F
authors.lastname: Clarke
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006689:Hodgkin Disease / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult