title: Autologous stem cell transplant for early relapsed/refractory Hodgkin lymphoma: results from two transplant centres.
abstract: Prior series have demonstrated that early relapsed (within 1 year) or refractory Hodgkin lymphoma (HL) is associated with poor prognosis. To determine the outcome for patients with early relapsed/refractory HL in the modern era, we combined data from two large transplant centres, Cleveland Clinic Taussig Cancer Institute (CCTCI) and Memorial Sloan-Kettering Cancer Center (MSKCC), and analysed consecutive patients transplanted for relapsed/refractory HL following induction failure or remission durations of <1 year. Two hundred and fourteen patients were analysed and the event-free survival (EFS) and overall survival (OS) at 6 years for all patients were 45% and 55%, respectively. Factors significant for prognosis in multivariate analysis were extranodal disease and bulky disease (≥5 cm). Patients with 0, 1, or 2 risk factors achieved 6 year EFS of 65%, 47%, and 24% and 6 year OS of 81%, 55%, and 27%, respectively. Patients with the sole risk factor of early relapsed/refractory disease achieved good outcomes in this large series; however the presence of bulk and/or extranodal disease significantly reduced EFS and OS. Patients with these additional risk factors are best suited for clinical trials investigating novel salvage regimens and post-transplant maintenance strategies.
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Smith
authors.forename: Craig H
authors.initials: CH
authors.lastname: Moskowitz
authors.forename: Robert
authors.initials: R
authors.lastname: Dean
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
authors.forename: Steven
authors.initials: S
authors.lastname: Andresen
authors.forename: Brian
authors.initials: B
authors.lastname: Bolwell
authors.forename: Jocelyn C
authors.initials: JC
authors.lastname: Maragulia
authors.forename: Jill M
authors.initials: JM
authors.lastname: Vanak
authors.forename: John
authors.initials: J
authors.lastname: Sweetenham
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Moskowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000627:therapeutic use; D003606:Dacarbazine / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D004812:Epidemiologic Methods; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin