title: Late relapses following high-dose autologous stem cell transplantation (HD-ASCT) for Hodgkin's lymphoma (HL) in the ABVD therapeutic era.
abstract: Salvage chemotherapy followed by high-dose autologous stem cell transplantation (HD-ASCT) is the standard of care for patients who have relapsed or refractory Hodgkin's lymphoma (HL). Few trials have had long-term follow-up post-HD-ASCT in the ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) era of treatment. We reviewed 95 consecutive patients who received HD-ASCT for relapsed or refractory HL following ABVD failure between 1990 and 2006 at the University of Rochester. Median follow-up for survivors was 8.2 years. All patients received HD-ASCT following upfront ABVD (or equivalent) failure. At 5 years, overall survival (OS) and event-free survival (EFS) were 54% and 37%, respectively. In total, 54 patients have died; 37 of these patients died directly of HL. Notably, there were 19 deaths >3 years post-HD-ASCT and 13 of these late deaths are directly attributable to HL. Furthermore, there were 51 documented relapses, 9 of which occurred >3 years post-HD-ASCT. In contrast to other studies, we did not observe a plateau in EFS following transplantation. Patients appear to be at continuous risk of recurrence beyond 3 years after HD-ASCT. Our results emphasize the importance of long-term follow-up for both toxicity and recurrence, and have important implications in defining success of posttransplantation maintenance strategies.
authors.affiliation: James P. Wilmot Cancer Center, University of Rochester, Rochester, New York 14642, USA.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Keller
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kelly
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sensenig
authors.forename: Jennifer
authors.initials: J
authors.lastname: Andreozzi
authors.forename: Jamie
authors.initials: J
authors.lastname: Oliva
authors.forename: Lynn
authors.initials: L
authors.lastname: Rich
authors.forename: Louis
authors.initials: L
authors.lastname: Constine
authors.forename: Michael
authors.initials: M
authors.lastname: Becker
authors.forename: Gordon
authors.initials: G
authors.lastname: Phillips
authors.forename: Jane
authors.initials: J
authors.lastname: Liesveld
authors.forename: Richard I
authors.initials: RI
authors.lastname: Fisher
authors.forename: Steven H
authors.initials: SH
authors.lastname: Bernstein
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000627:therapeutic use; D003606:Dacarbazine / Q000008:administration & dosage / Q000627:therapeutic use; D019468:Disease Management; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006689:Hodgkin Disease / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016879:Salvage Therapy; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014747:Vinblastine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin