title: Outcomes of Hodgkin's lymphoma patients with relapse or progression following autologous hematopoietic cell transplantation.
abstract: Patients with relapsed/progressed Hodgkin's lymphoma (HL) following autologous hematopoietic cell transplantation (AHCT) may not have an invariably dismal outcome as previously considered. In a multicenter retrospective study, we evaluated 126 patients who relapsed/progressed after a median of 5 (1-132) months post first AHCT. Management consisted of irradiation, chemotherapy ± irradiation, second HCT, or palliation. Currently, 53 of 126 (42%) patients are alive for a median of 32 months since relapse/progression and 44 (35%) of them remain progression-free. Interval of <12 months to relapse/progression, presence of B-symptoms, and disease refractoriness at first AHCT failure adversely influenced overall survival (P < .05). The type of treatment had no impact on survival. Furthermore, to predict the outcome at the time of relapse/progression, we constructed a prognostic model based on 3 factors: interval of <12 months from first AHCT to relapse/progression, presence of B-symptoms, and pre-AHCT disease refractoriness. Patients with 0 to 1 factors achieved a median survival of 70 months compared to 17 months only in those with 2 to 3 factors (P < .001). This study, the largest reported to date, suggests that selected patients with relapse/progression after first AHCT can be rescued with current treatment modalities. However, relapsed/progressed HL following AHCT still poses a therapeutic challenge, and prospective trials are needed to determine the most appropriate approach in this setting.
authors.affiliation: Department of Haematology, BMT-Unit, George Papanicolaou Hospital, Thessaloniki, Greece. pkaloyannidis@yahoo.gr
authors.forename: Panayotis
authors.initials: P
authors.lastname: Kaloyannidis
authors.forename: Georgia
authors.initials: G
authors.lastname: Voutiadou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Baltadakis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsirigotis
authors.forename: Alexandros
authors.initials: A
authors.lastname: Spyridonidis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Repousis
authors.forename: Artemisia
authors.initials: A
authors.lastname: Balta
authors.forename: Simeon
authors.initials: S
authors.lastname: Tsimberis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karakasis
authors.forename: Ioanna
authors.initials: I
authors.lastname: Sakellari
authors.forename: Ioannis
authors.initials: I
authors.lastname: Dervenoulas
authors.forename: Nicholas
authors.initials: N
authors.lastname: Harhalakis
authors.forename: Achilles
authors.initials: A
authors.lastname: Anagnostopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult